UNivE^sinr  OP     I 

CALIFORNIA  \ 


Date  Due 


NOV  10 1970 


2' 


NOV  1  [  REC'O 


AUG  5 


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MAY 


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DECfi    1981 

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CAT.    NO      ?3    233 


PRINTED    IN    U.S.A. 


3  1822  01317  0071 


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RENOUARD'S 

HISTORY  OF  MEDICINE. 


SYNOPTIC  TABLE  OF  CONTEXTS  OF  RENOUARD'S 
HISTORY  OF  MEDICINE. 


I.  AGE  OF  FOUNDATION. 


1.  Primitive  Period;  From  the  Origiu  of  Society  to   the  De- 

struction of  Troy,  1184,  B.  0. 

2.  Sacred  or  Mystic  Period  :  Ending  with  the  Dispersion  of 

the  Pythagoreans,  500,  B.  C. 

3.  Philosophic    Period  :    Ending   at    the    Foundation    of   the 

Alexandrian  Library.  320.  B.  C. 

4.  Anatomical  Period:  Ending  at  the  Death  i)f  (lalen.  A.D. 

200. 

II.    AGE  OF  TRANSITION. 

•5.  Greek  Period  :  Ending  at  the  Burning  of  the  Alexandrian 
Library,  A.D.  640. 

6.  Arabic  Period  :  Ending  at  the  Revival  of  Letters  in  Europe, 

A.D.  1400. 

III.    AGE  OF  RENOVATION. 

7.  Erudite  Period:  Comprising  the  Fifteenth   and    Sixteenth 

Centuries. 

8.  Reform  Period  :  Comprising  the  Seventeenth  and  Eighteenth 

Centuries. 


From  the  pjiges  of  Dr.  Keuouard,  a  very  accurate  acqiiaiutaiice  may  be 
obtained  with  the  history  of  medicine — its  relation  to  civilization,  its  prog- 
ress compared  with  other  sciences  and  arts,  its  more  distinguished  culti- 
vators, with  the  several  theories  and  systems  proposed  by  them ;  and  its 
relationship  to  the  reigning  philosophical  dogmas  of  the  several  periods. 
His  historical  narrative  is  clear  and  concise — tracing  the  progress  of  medi- 
cine through  its  three  ages  or  epochs — that  of  foundation  or  origin,  that  of 
tradition,  and  that  of  renovation. — Am.  Journal  of  Medical  Science. 

It  is  expressly  from  the  conviction  of  the  deficiency  of  the  English  lan- 
guage in  works  on  the  History  of  Medicine,  that  we  feel  indebted  to  Dr. 
Comegys  for  the  excellent  translation  of  the  comparatively  recent  work  of 
Eenouard.  We  hope  before  long  to  find  that  in  every  important  school  of 
medicine  in  this  country,  opportunities  will  be  ottered  to  students  whereby 
they  may  be  enabled  to  attain  some  knowledge  at  least  of  the  history  of  that 
profession  to  the  practice  of  which  their  lives  are  to  be  devoted. — British  and 
Foreign  Medico- C'hirur(/ical  Review. 

The  best  history  of  medicine  extant,  and  one  that  will  find  a  place  in  the 
library  of  every  physician  who  aims  at  an  acquaintance  with  the  past  history 
of  his  profession.  "-  *  *  There  are  many  items  in  it  we  should  like  to 
offer  for  the  instruction  and  amusement  of  our  readers. — Ameiican  Journal 
of  Pharmacy. 


HISTORY 


MEDICINE, 


ORIGIN  TO  THE  NLNETEEXTH  CENTURY, 


WITH  AN  APPENDIX. 


CONTAINING    A    PHILOSOPHICAL    AND    HISTORICAL    REVIEW    OF    MEbU  INK 
TO    THE    PRESENT    TIME. 


BY 

P.  V.  RENOUARD.  M.  D. 


Tbe   Scn;iii-«  are   srailually  developed.     It  is  only  by  reviewing  past   centuries  that  we  can 
determine  their  laws  of  growth. 


TRANSLATED  FKOM  THE  FRENCH  BT 

CORNELIUS  a.  COMEGYS,  M.  D., 

PBOFMSOR   OF   THE    INSTITUTES    AND   OF   CLINICAL    MEDICINE,    IN    THE   MEDICAL   COLLFiiK   OF    OHIO. 


PHILADELPHIA  : 

LINDSAY   &    BLAKISTON. 

18G7. 


Entered  according  to  Act  of  Congress,  in  the  year  1855.  by 

MOORE,  WILSTACH,   KKYS  &  CO.. 

In  the  Clerk's  Office  of  the  District  Court  of  the  United  States  for  the  Southern  District  of  Ohio. 


€  0   t  ij  t    ^|l  e  m  0  r  it 


0  F 


M  Y    FATHER, 

CORNELIUS   P.    COMEGYS, 

LATE  GOVERNOR  OF  DELAWARE, 

AND 

MY    PRECEPTOK, 

WILLIAM    E.    HOE  NEE,    M.   D.. 

L  A  T  K    P  E  O  F  .    OF    ANATOMY    IN    THE    t'  X  I  V  E  R  3  I  T  Y    OF    T  E  N  N  S  Y  L  V  A  N  I  A 
THE     LABORS      OF 

THE   TRANSLATOR 

ARE     AFFECTIONATELY     AND 

GRATEFULLY'      INSCRIBED. 


TRANSLATOR'S  PREFACE. 


In  producing  the  work  of  Dr.  Eenouard  in  the  English  language,  1 
have  been  actuated  by  the  conviction  that  a  treatise  of  its  nature  is  greatly 
needed.  Indeed,  if  I  except  brief  sketches  affixed  to  some  of  our  spe- 
cial treatises,  we  possess  nothing  in  our  literature  that  is  at  all  cal- 
culated to  satisfy  the  wants  of  the  profession  in  this  respect.  The  only 
work  on  this  subject,  of  any  magnitude,  by  an  English  author,  is  that 
of  Dr.  Freind,  which  is  a  continuation  of  Le  Clerc,  and  comes  down 
only  to  the  beginning  of  the  sixteenth  century ;  besides,  it  is  out  of 
print. 

Why  no  history  of  Medicine  commensurate  with  the  dignity  and  extent 
of  our  profession  has  yet  been  written  in  our  tongue,  I  am  entirely 
unable  to  explain.  Other  languages  are  prolific  enough  in  this  respect, 
particularly  the  German  and  the  French.  To  obtain  any  scholarly 
attainments  on  this  subject,  it  has  been  necessary  to  read  books  in  for- 
eign languages.  Knowing,  therefore,  the  wants  of  the  profession,  and 
having  been  greatly  encouraged  by  medical  gentlemen  in  diffisrent  por- 
tions of  the  Union,  to  whom  I  have  communicated  my  design,  I  have 
ventured  to  offer  this  translation  to  fill  this  vacuum  in  our  medical 
literature.  I  have  hesitated  to  enter  into  this  very  difficult  field  of 
authorship,  from  a  real  distrust  of  my  abilities  for  the  task ;  and  now 
that  it  is  done,  many  errors  are  plainly  visible.  Some  are  minor  ones, 
and  are  such  as  wiU  creep  into  publications  in  spite  of  the  utmost  care. 
There  are  others,  more  serious,  which  I  would  gladly  correct,  and  hope 
to  have  an  opportunity  of  doing  so  at  another  time.  Few  of  them,  how- 
ever, impair  in  any  great  degree  the  original,  and  do  not,  therefore, 
materially  pervert  the  author's  meaning.     My  professional  brethren  will 


viu  translator's  preface. 

be  kind  in  their  criticism,  when  they  remember  that  the  active  duties 
of  our  profession  are  most  unpropitious  to  literary  pursuits. 

The  work  of  Dr.  Eenouard  should  be  studied  in  several  aspects ; 
first,  as  a  historical  narrative,  in  which  the  relation  of  Medicine  to  civ- 
ilization is  shown,  and  its  progress  compared  with  that  of  the  sciences  and 
arts ;  secondly,  in  the  histoiy  of  its  cultivators,  with  the  theories  and 
systems  which  they  have  proposed  ;  thirdly,  the  relation  of  medical  to 
philosophical  theories ;  lastly,  the  great  argument  of  the  author :  Empi- 
ricism or  the  Empirical  method  is  alone  applicable  to  the  cultivation  of 
Medicine,  and  therapeutics,  not  physio-pathology,  the  foundation  upon 
which  the  science  rests. 

In  these  respects  the  author  has  acquitted  himself  as  fully  as  the 
limits  of  an  elementary  treatise  will  allow,  and  particularly  in  his  dis- 
cussion of  philosophic  methods  and  on  the  general  subject  of  metaphysics 
he  has  presented  one  of  the  clearest,  most  comprehensive,  yet  condensed 
expositions  that  any  single  work  aifords,  and  it  will  thoroughly  prepare 
the  reader  to  appreciate  properly  his  main  argument. 

Many  eminent  minds  in  our  profession  are  steadily  at  work  endeav- 
oring to  build  up  Medicine,  like  other  branches  of  natural  science,  by  the 
careful  study  of  facts.  We  have  millions  of  well  attested  observations,  and 
if  our  reason  is  invoked,  in  the  language  of  Kant,  only  to  guide  experience 
in  the  careful  study  and  co-ordination  of  these  facts,  we  shall  be  able 
by  induction  to  reach  those  great  general  principles  or  axioms  that 
shall  give  our  science  a  lofty  rank  among  kindred  sciences  for  complete- 
ness and  certainty.  I  humbly  think  that  the  work  of  Dr.  Eenouard  will 
greatly  aid  in  this  conquest,  by  turning  the  mass  of  medical  mind  from 
the  vain  efforts  of  speculation  to  the  tried  and  fruitful  path  of  observa- 
tion. But  this  is  a  laborious  route,  and  its  difficulties  were  early 
expressed  by  Hippocrates,  in  his  well  known  Aphorism :  life  is  short, 
art  is  long,  experience  deceptive,  judgment  difficult. 

The  uncertainty  of  Medicine,  and  the  different  opinions  of  those  who 
cultivate  it,  are  often  referred  to  as  an  evidence  of  its  low  rank  as  a 
science ;  yet  I  believe  that,  excepting  mathematics  and  pursuits  resting 
strictly  upon  it,  no  pursuit  of  man  surpasses  or  equals  Medicine  iu  the 
certainty  of  its  opinions,  and  in  its  positive  and  increasing  blessings  to 
society.     AVe  do  not  assume  that  Medicine,  as  a  science  or  an  art,  is 


translator's   preface.  IX 

now  perfect ;  on  the  contrary,  none  feel  its  defects  more  keenly  than 
medical  men ;  yet  we  know  that  a  steady  and  brilliant  improvement  is  in 
progress. 

When  we  examine  other  professions,  it  is  very  plainly  seen  that  there 
is  as  much  uncertainty  and  want  of  uniformity  in  opinions  as  in  ours. 

In  theology,  learned  bodies  are  divided,  not  in  regard  to  speculations 
about  mysteries  more  than  in  the  meaning  of  words  and  the  interpreta- 
tion of  phrases,  access  being  had  by  aU  parties  to  the  same  sources  of 
knowledge,  to  enable  them  to  settle  these  questions.  These  varieties 
are  seen  in  confessions  of  faith,  administration  of  ordinances,  and 
church  government. 

The  law  is  said  to  be  the  perfection  of  human  reason  ;  but  if  Medi- 
cine is  proverbially  uncertain,  what  may  not  be  said  of  law  ?  Its  doc- 
trines are  written,  its  decisions  are  voluminous,  and  moreover,  the 
whole  science  may  be  narrowed  down  to  a  question  of  right  and  wrong, 
in  which  the  whole  moral  faculties  of  man  instinctively  lead  the  judge 
to  decide  aright.  In  nothing  have  men  more  intuitive  knowledge  than 
in  law.  It  may  be  said  that  legal  decisions  are  uncertain,  because  evi- 
dence is  defective.  This  is  granted,  but  its  uncertainty  is  seen  as  fre- 
quently in  interpretations  of  organic  as  of  common  law.  The  opinions  of 
lawyers  are  given  with  great  deliberation,  with  ample  opportunity  for 
research,  while  doctors  are  expected  to  be  ready  at  a  moment's  warning 
to  decide  the  most  momentous  questions ;  and  I  have  no  hesitation  in 
saying  that  the  opinions  of  medical  men,  thus  given  on  the  spur  of  the 
moment,  are  characterized  by  as  much  certainty  as  those  of  lawyers. 

Let  us  compare  Medicine  with  political  economy.  Are  our  statesmen 
unanimous  in  their  views  on  the  subjects  of  domestic  manufacturino-, 
tariffs,  banks  of  issue,  internal  improvements,  educational  systems, 
modes  of  taxation,  currency,  the  general  rights  of  citizens,  and  on  other 
highly  important  topics  ? 

The  movements  of  the  mercantile  and  manufacturing  world  rest  upon 
calculations  or  estimates,  but  of  all  pursuits  none  are  so  uncertain.  A 
very  small  number  of  men  who  embark  in  commerce  and  manufactur- 
ing succeed.  These  noble  occupations,  which  are  most  important  ele- 
ments in  the  progress  of  civiliziation,  offer  but  little  hope  of  permanent 
success. 


X  translator's  preface. 

Uncertainty  marks  also  tte  estimates  of  engineers  and  architects, 
althougli  it  would  seem  that  ample  data  are  in  their  possession  to  give 
great  precision  to  their  statements. 

Navigation,  so  far  as  it  relates  to  mathematics,  is  remarkably  accu- 
rate. The  ship  is  guided  from  port  to  port,  and  throughout  her  voyage 
her  exact  position  on  the  surface  of  the  ocean  can  he  defined.  These 
calculations  are  founded  on  the  movements  of  the  heavenly  bodies  ;  but 
the  opinions  of  the  captain  in  regard  to  the  •weather,  and  the  duration 
of  his  voyage,  are  all  uncertain.  When  he  encounters  the  commotions 
of  nature,  the  fierce  tempest,  and  the  surging  ocean,  he  has  no  more 
certainty  of  saving  his  ship  and  crew,  than  the  physician  who  struggles 
with  the  conflicts  of  nature  in  the  human  organism. 

My  brief  space  will  not  allow  me  to  say  more  on  this  topic,  but  these 
examples  will  contribute  somewhat,  I  trust,  to  wipe  ofi"  the  stigma  of 
the  greater  uncertainty  in  Medicine  than  in  other  pursuits. 

Our  science  is  also  reproached  with  being  stationary.  Thus  it  is  said 
that  while  society  has  been  flooded  with  light  on  other  topics,  and  civili- 
zation has  improved  steadily.  Medicine  has  contributed  an  inferior  share 
to  this  progress.  Nothing  can  be  more  unfounded  than  these  statements. 
If  we  examine  the  great  eras  in  civilization,  Medicine  will  be  found  to 
have  progressed  as  rapidly  as  the  physical  sciences  generally.  The  dis- 
coveries of  Columbus,  and  successive  navigators,  were  not  earlier  nor 
more  important  in  geography,  than  those  of  Mondini,  Beranger,  Vesa- 
lius,  and  Sylvius,  in  anatomy.  Copernicus  did  not  earlier  conceive  the 
errors  of  the  Ptolemaic  astronomy,  than  Servetus,  E.  Columbus,  and 
Cesalpine  the  errors  of  Galenic  physiology ;  and  Galileo,  who  demon- 
strated the  movements  of  the  earth  and  planets  around  the  sun,  was  a 
cotemporary  with  Harvey,  who  demonstrated  the  circulation  of  the  blood. 
The  universal  law  of  Xewton  for  the  solar  system,  was  not  greatly  in 
advance  of  that  of  Haller  of  the  laws  and  special  forces  of  life.  If  the 
great  philosopher  established  that  the  force  manifested  in  the  fall  of  an 
apple  to  earth,  is  the  same  as  that  which  keeps  the  planets  in  their  orbits, 
so  the  pathologist  has  shown  that  the  laws  of  inflammation  in  the  deep- 
seated  and  vital  organs  are  identical  with  those  that  arc  seen  in  the 
smallest  inflammatory  point  on  the  skin.  And  how  much  might  be 
added  on  the  application  of  ph}  sical  laws  in  diagnosis,  the  prevention 


TRANSLATOR'S   PREFACE.  XI 

of  small  pox,  the  easy  cure  of  autumnal  fever,  etc.,  to  show  that  in  point 
of  progress  Medicine  marches  hand  in  hand  with  kindred  sciences. 

Literature  and  the  fine  arts  offer  no  comparison  in  this  respect  to 
Medicine.  Our  oratory  does  not  surpass  that  of  Greece  and  Eome. 
Where  have  we  profounder  reflective  philosophers  than  Pythagoras  and 
Plato  of  the  ancients,  and  Locke  and  Descartes  of  moderns  ?  What 
astronomers  are  adding  anything  to  the  laws  developed  by  Xewton,  Kep- 
ler, and  La  Place  ?  In  sculpture  we  only  equal  ancient  Greece.  Our 
paintings  are  not  esteemed  like  those  of  the  old  masters.  Our  jurists 
do  not  surpass  the  Erskines  and  Blackstones.  "  Except  the  writings  of 
Lord  Mansfield  on  commercial  law,"  says  a  late  writer,  "  nothing  impor- 
tant has  been  added  for  many  years,  and  no  great  errors  have  been 
expunged."  In  statesmanship,  the  present  generation  will  scarcely  rival 
the  past.  Who  shall  fill  the  senatorial  chairs  of  Clay,  Calhoun,  Wright, 
and  Webster "?  The  present  commentators  on  the  Bible  are  not  superior 
to  those  who  have  passed  away  ;  our  writers  on  moral  science  are  largely 
copyists  of  old  authors ;  our  poets  and  prose  writers  do  not  surpass  our 
classics.  There  is  no  progress  in  mathematics ;  the  most  eminent  intel- 
lects are  only  able  to  master  the  inventions  of  Euclid,  Newton,  and 
Leibnitz. 

In  what,  then,  is  the  progress  of  this  stimng  age  ?  It  is  not  in  the- 
ology, law,  belles-letters,  the  fine  arts,  architecture,  politics,  mathemat- 
ics, or  metaphysics.  It  is  in  mechanics  and  the  chemical  and  physical 
sciences,  in  which  our  science  forms  an  integral  part.  Man  is  strug- 
gling to  regain  what  was  his  primeval  inheritance  "  before  the  fall 
brought  ruin  on  our  race,"  when  God  said,  showing  him  animate  and 
inanimate  nature,  "have  dominion."  We  see  this  in  his  control  of  the 
electrical  element,  which  enables  him  to  imitate  the  ubiquity  of  God  ; 
in  employing  the  winds  to  waft  his  graceful  ships ;  in  the  ocean  steamer, 
which  drives  its  prow  in  the  teeth  of  the  powerful  north-wester,  and 
beats  down  the  waves  that  vainly  dispute  its  passage ;  in  the  tunneled 
mountain,  whose  icy  peaks  are  reared  in  vain  to  barricade  the  route  of 
his  locomotive ;  in-  employing  the  sun's  rays  to  stamp  his  features  on 
the  metalic  plate,  that  the  perfect  image  of  his  loved  ones  may  remain 
long  after  their  frames  have  mouldered  into  dust. 


xii  translator's  preface. 

Medicine  relates  to  nature,  its  preservation  and  defence,  and  nothing 
that  man  possesses  surpasses  it  in  ameliorating  the  condition  of  the  race. 
Our  progress  is  not  only  in  the  structural  knowledge  of  the  system,  and 
its  life  laws,  but  our  resources  for  the  treatment  of  diseases  are  enlarged. 
The  horror  of  surgical  operations  is  abated  by  the  fact  that  the  severest 
work  of  the  knife  may  now  be  endured  while  the  mind  is  as  blissful 
as  if  wandering  in  Elysian  fields. 

But  I  must  not  deal  in  words  only.  We  have  undisputed  figures  to 
prove  "that  our  science  is  a  vast  blessing  to  the  race.  I  will  not  allude 
to  individual  cases,  to  which  every  one  can  bear  some  testimony  of  its 
success,  but  take  the  broad  results  of  vital  statistics. 

The  epidemics  that  formerly  terrified  the  nations,  leaving  in  their 
trail  desolations  worse  than  the  tornado,  have  been  shorn  of  their  terrors. 
The  prevalence  of  small  pox  has  been  almost  prevented  by  Jenner's  discov- 
ery of  vaccination.  The  treatment  of  cholera  is  now  so  well  understood 
that  it  has  lost  its  former  desolating  power.  Human  life  has  been  greatly 
lengthened  in  the  last  hundred  years.  The  reports  of  the  Parisian 
hospitals  show  that  while  in  1805  one  died  in  seven  who  were  admitted, 
now  only  one  dies  in  twelve,  thus  showing  that  our  science  has  increased 
in  its  ability  to  save  life  in  the  same  order  of  diseases,  and  in  the  same 
buildings,  seventy-one  per  cent  in  a  period  of  fifty  years.  In  other 
words,  in  the  Paris  hospitals,  where,  fonnerly,  fourteen  men  died  in  each 
hundred  admitted,  now  only  eight  die,  a  saving  of  six  persons  in  a 
hundred ;  and  in  the  eighty  thousand  who  annually  pass  through  those 
wards,  a  saving  of  five  hundred  human  beings.  And  this  is  not  all ; 
the  period  of  their  stay  is  very  much  lessened.  The  average  time  of 
residence  was  formerly  thirty-nine  days,  now  it  is  twenty-four  days,  a 
a  diflference  of  fifteen  days  since  1805.  In  the  treatment  of  special  dis- 
eases, the  most  remarkable  evidences  of  improvement  are  shown. 
Thus,  in  syphilis,  in  1805,  one  died  in  fifty-six  cases ;  now  (1850)  only 
one  died  in  two  hundred  and  ninety-four. 

In  England,  according  to  Macaulay,  "the  term  of  human  life  has 
been  greatly  lengthened  in  the  whole  kingdom.  In  1G85,  not  a  sickly 
year,  one  in  twenty  of  the  inhabitants  of  London  died,  while  at  pres- 
ent  only  one  in  forty  dies.     The  diff"erence  between  London  in   the 


translator's  preface.  XIU 

seventeenth  and  London  in  the  nineteenth  century  is  as  great  as  between 
London  in  ordinary  years  and  London  in  the  cholera." 

In  surgical  practice,  the  saving  of  life  at  present  exceeds  by  more 
than  thirty-five  per  cent,  the  results  at  the  beginning  of  this  century. 
The  returns  of  the  Registrar  General  of  England  show  a  steady  and  nota- 
ble decrease  in  the  rate  of  mortality  from  1838  (the  beginning  of  the 
returns)  to  1845  ;  in  1846  it  rose  again,  ascribable  to  the  prevalence  of 
epidemic  intestinal  diseases.  In  France,  according  to  Dapin,  the  dura- 
tion of  life  has  been  increasing,  equal  to  fifty-two  days  for  each  year 
from  1776  to  1842,  or  nine  and  a  half  years  for  the  whole  period.  The 
increase  per  annum  was  at  no  time  less  than  nineteen  days,  although 
that  revolutionary  and  warlike  nation  shed  seas  of  blood,  not  only  in 
her  cities,  but  upon  every  battle  field  in  Europe.  In  midwifery  prac- 
tice, one  hundred  and  fifty  years  ago,  according  to  Dr.  Merriman,  one 
in  forty  died.  At  the  close  of  his  tables,  (1828,)  only  one  in  one  hun- 
dred and  seven  died,  and  at  this  time  perhaps  not  one  in  two  hundred 
and  fifty  dies.  The  hospital  practice  in  our  own  country  exhibits  the 
same  gratifying  success  in  treatment.  1  find  by  comparing  the  statistics 
of  the  Philadelphia  and  Xew  York  hospitals,  that  they  show  the  same 
results,  almost  to  a  fraction,  with  those  of  Paris.  In  short,  whether  we 
examine  the  reports  of  the  Eegistrar  General  of  England,  the  data  of  the 
Carlisle  and  Northampton  life  tables,  the  statistics  of  the  Bureau  Cen- 
trale  of  Paris,  or  the  publications  of  the  great  hospitals  of  our  own 
country,  the  same  results  are  presented.  Life  has  been  prolonged  more 
than  twenty-five  per  cent,  in  the  past  seventy-five  years,  and  the  dura- 
tion of  treatment  lessened  more  than  one-third.  Xow,  it  may  be  said 
that  the  cessation  of  wars,  and  the  amelioration  of  the  general  condi- 
tion of  the  masses,  explain  this  gain  in  human  life,  and  deprive  Medicine 
of  her  claim  to  such  titles  of  glory.  But  we  present  these  irrefutable 
hospital  reports;  their  wards  are  the  peculiar  battle-ground  of  the 
doctors,  and  showing  these  results,  we  demand  that  they  shall  be  expo- 
nents of  what  has  been  done  for  society  at  large — that  this  increased 
longevity  is  due  to  our  science. 

Who  supposes  its  power  to  benefit  mankind  can  not  be  immensely 
augmented?  "Who  is  content  that  it  should  be  stationary?  Certainly 
not  medical  men.     Its  higher  success  is  the  dream  of  their  lives  ;  they 


XIV  translator's  preface. 

gaze  into  a  hopeful  future,  and  are  filled  with  glowing  and  bright  pic- 
tures of  the  era  when  this  science  shall  be 

"  Above  the  reach  of  sacrilegious  hands, 

Whose  honors  with  increase  of  ages  grow, 

As  streams  roll  down,  enlarging  as  they  flow." 

Another  important  fact  is  well  established  by  the  perusal  of  this  his- 
tory, viz  :  that  Medicine  has  never  flourished  and  been  cultivated  in  the 
highest  degree  in  any  country  where  it  has  had  no  legal  recognition. 
The  want  of  such  recognition  and  legislation  is  painfully  felt  in  most  of 
the  "States  of  our  Union.  The  medical  profession  is  wholly  unprotected 
except  by  its  own  organization,  by  its  own  regulations ;  it  attempts  to 
encourage  a  sound  state  of  education  and  ethics,  yet  we  are  assailed 
continually  for  what  are  termed  our  prejudices  against  irregular 
practitioners. 

The  whole  series  of  phenomena  in  the  human  system  is  in  accordance 
with  the  laws  of  vitality,  precisely  as  the  endless  phenomena  of  the 
universe  are  developed  in  obedience  to  certain  laws.     When,  therefore, 
the  human  mechanism  becomes  deranged,  and  a  great  contest  is  set  up 
between  the  forces  of  disease  and  the  vital  forces,  who  shall  attempt  to 
interfere — the  man  who  has  made  these  laws  a  study,  who  knows  the 
operations  of  their  final  causes,  who  comprehends  as  far  as  science  has 
shed  light  upon  the  subject,  their  special  and  general  operations,  or  the 
man  who  is  ignorant  of  the  entire  mechanism,   and  laying  aside  all 
such  labor  and  investigation,  attempts  to  rescue  the  sufiering  system  by 
remedies  which,  according  to  his  gross  views,  have  been  successful  in  a 
similar  case  ?     Legislation  offers  no  obstacle  to  the  latter.     It  is  true 
that  it  has  legalized  the  medical  college    and  its  diploma,  but  the 
learned  and  laborious  graduate  has  no  legal  level  above  the  quack ;  the 
latter  has  just  as  full  authority  to  practice.     If  any  one,  deceived  by 
the  puffing  of  the  self-styled  doctors,  falls  a  victim  to  their  ignorance, 
the  law  kindly  allows  a  jH-osecution  for  mal-practice  !     An  irreparable 
injury,  or  even  death  itself  may  be  the  result  of  this  ignorant  interfe- 
rence, and  what  atonement  then  does  the  prosecution  of  an  irrespon- 
sible man  afford  ? 

In  regard  to  Medicine,  every  one  must  look  out  for  himself.     With 


translator's   preface.  XV 

the  same  indifference,  we  ought  not  to  have  a  standard  of  weights  and 
measures,  nor  a  fixed  value  of  coin,  nor  protection  against  issues  of 
paper  money.  Let  every  one  take  care  of  himself.  Why  not  have 
a  board  of  examiners  of  candidates  for  medical  practice,  as  we  have  for 
law  and  teaching  ?  Xo  man  can  assume  to  be  a  respectable  minister  of  the 
gospel  without  the  license  of  a  church  organization ;  no  man  can  prac- 
tice law  without  an  approved  examination  before  a  court ;  no  man  can 
teach  without  a  certificate  of  qualifications ;  no  man  can  sell  goods  or 
peddle  goods,  or  drive  a  dray,  or  a  cab,  or  an  express  wagon,  without 
registering  and  a  license.  The  public  is  defended  from  the  impositions 
of  the  hackney  coachman,  but  not  from  the  quack  doctor  and  patent 
medicine  vender.  Xo  man  is  believed  te  be  a  carpenter,  or  a  machinist, 
or  a  master  in  any  other  profession,  unless  he  has  served  an  apprentice- 
ship to  it.  Then  why,  I  ask,  in  the  name  of  humanity  and  civilization, 
when  we  come  to  consider  the  human  frame,  the  most  wonderful  struc- 
ture of  God,  the  divine  idea  of  mechanism,  in  whose  structure  a  thous- 
and wonderful  and  complicated  actions  are  in  flay,  many  of  whose 
laws,  after  more  than  two  thousand  years  of  investigation,  are  still 
unknown,  why,  I  say,  do  our  governments  surrender  this  beautiful 
structure  to  be  prostituted  to  the  mercenary  practices  of  charlatans  ? 

When  we  think  what  interest  Deity  has  taken  in  diseased  humanity, 
inspiring  Moses  to  write  those  extraordinary  precepts  found  in  Deu- 
teronomy, how  he  conferred  on  priest  and  prophet  healing  powers ;  that 
Jesus  performed  the  functions  of  a  physician  as  well  as  that  of  a  divine 
teacher,  and  endowed  his  apostles  with  power  to  heal  the  sick,  thus 
sanctioning  the  profession  of  Medicine,  as  well  as  giving  proofs  of  a 
divine  nature ;  that  the  ancient  civilization  of  Greece  and  Eome  legal- 
ized Medicine,  and  all  modem  Europe  lavishes  upon  it  favors  and 
protects  it  from  impostors ;  why,  I  repeat,  in  this  great  Eepublic,  is  this 
learned  and  valuable  profession  unsustained,  and  society  unprotected? 

The  profession  must  appeal  to  legislation,  not  to  ask  for  laws  that 
shall  compel  a  man  to  profess  the  doctrines  of  a  certain  school,  but 
that  no  one  shall  be  allowed  to  treat  diseases,  whether  he  calls  him- 
self allopath,  homeopath,  isopath,  physiopath,  eclectic,  botanic,  or  by 
any  other  name,  until  he  has  shown  before  a  proper  tribunal  that 
he  has  made  the  organism  of  man  and  his  diseases,  a  special  study. 


xvi  translator's  preface. 

This  is  simple  and  fair,  and  society  owes  this,  not  only  to  itself  as  self- 
protection,  but  also  as  a  tribute  of  respect  to  the  medical  profession. 
"  For,"  in  the  language  of  Dr.  Willis,  "  who,  since  the  revival  of  learning, 
have  done  more  for  every  undertaking  whose  object  has  been  to  extend  the 
boundaries  of  knowledge  and  to  exalt  mankind  ?  Who  knows  half  so 
much  of  the  wants  and  the  wishes,  of  the  joys  and  sorrows  of  the  com- 
munity ?  Who  are  the  friends  and  comforters  in  adversity  especially, 
of  persons  in  every  grade  of  life,  from  the  sovereign  to  the  wretched 
outcasts  of  the  streets,  houseless,  homeless,  friendless,  alone?  Who 
disarms  pestilence  of  its  powers,  and  gives  Jenners  to  the  world  ?  Who 
follow  in  the  battle  field,  through  the  thickest  of  the  fire,  not  that  they 
may  aid  destruction  in  her  work,  but  that  they  may  staunch  the  wounds 
she  makes  ?  The  servant  of  religion  hath  not  more  of  true  sanctity 
about  him  than  the  good  physician.  The  service,  indeed,  that  was  ren- 
dered of  old  in  special  temples  to  the  Divinity,  conceived  in  one  of  his 
most  beautiful  attributes,  is  not  yet  extinct  upon  earth,  but  has  its 
ministering  [priest,  ennobled  by  Christianity,  in  every  worthy  member 
of  the  profession.  Oh,  let  society  cherish  and  exalt  its  medical  com- 
munity ;  let  it  become  awai-e  that  if  science  can  not  aid  it  in  its  strug- 
gles with  disease,  neither  can  ignorance  ;  that  nothing  can  by  possibility 
be  known  to  the  quacksalver  and  ignorant  empiric  that  is  not  famil- 
iar to  the  educated  physician  ;  that  a  youth  of  devotion  to  his  Art, 
is  all  too  little  to  familiarize  him  with  all  the  varieties  of  disease,  and 
the  means  of  meeting  them  successfully  ;  and  that  there  is  no  access  to 
the  temple  of  JNIedicine  save  through  the  intimate  knowledge  of  the 
laws  by  which  we  live,  and  move,  and  have  our  being." 

Cincinnati,  No,  258  Race  Street,  November  1,  1855. 


INTRODUCTION. 


"  In  order  to  study  and  practice  Medicine  in  a  proper  manner,  it  is 
necessary  to  be  impressed  with  its  importance  ;  and  to  be  so  impressed. 
we  must  believe  in  it.""  These  words  of  a  philosophic  physician, 
whose  life  and  writings  breathe  a  sincere  philanthropy,  contain  a  deep 
sense,  which  constitutes,  according  to  my  opinion,  the  moral  base  of  all 
Medical  Practice.  It  is  evident,  indeed,  that  the  practitioner  who  has 
no  faith  in  the  efficacy  of  his  art,  can  not  devote  himself  to  the  study 
and  practice  of  it,  with  the  necessary  zeal,  and  perseverance.  But,  it 
will  not  suffice  for  the  physician  only  to  be  convinced  of  the  utility  of 
the  remedies  he  prescribes  ;  it  is  also  very  advantageous  to  the  success 
of  the  treatment,  if  the  patient  share  his  confidence  in  them.  It  is. 
then,  important  to  all  of  us,  to  form  early  a  reasonable  opinion  on  the 
degree  of  efficacy  and  certainty  that  may  be  attained  in  medicine.  Now, 
we  shall  not  be  able  to  draw  the  motives  of  such  an  opinion  from  any 
better  source  than  the  history  of  this  science. 

Another  question  which,  though  less  important,  does  not  lack  interest. 
is,  "What  is  the  origin  of  the  Healing  Art  ?  Has  it  sprung  from  the 
natural  wants  of  man,  or  rather,  as  some  ancient  and  modern  philoso- 
phers have  pretended,  is  it  only  an  evidence  of  the  degeneration  of  the 
human  species  ?  It  belongs  to  history  alone  to  resolve  this  question  in 
a  decisive  manner ;  for,  if  it  appears  from  the  most  undoubted  tradi- 
tions, that  there  does  not  exist,  and  never  has  existed  a  people,  whether 
savage  or  civilized,  who  have  not  had  some  species  or  other  of  Medicine, 
we  are  compelled  to  conclude  from  this,  that  this  art  is  destined  to  sat- 
isfy an  irresistible,  imperious  and  natural  want ;  and  not  a  factitious 
one  proceeding  from  effeminate  habits,  or  some  other  vice  of  civilization. 

Medicine,  whose  history  I  have  endeavored  to  trace,  was  called,  in  its 
origin,  the  Art  of  Healing.     It  consisted  at  that  time,  in  a  succinct 


Cabanis.     "  Du  Degre  de  Certitude  de  la  Mcdecine,"  Preface,  page  1. 
1 


X  INTRODUCTION. 

description  of  diseases,  which  had  been  observed,  and  the  indication  of  the 
remedies  employed  to  combat  them.  These  two  parts  correspond  to  what, 
at  this  day,  are  named  Nosology  and  Therapeutics ;  they  relate  to  man 
in  a  state  of  disease  only. 

Subsequently,  those  who  devoted  themselves  to  the  practice  of  Medi- 
cine, enlarged,  gradually,  the  field  of  their  observations.  Nosological 
descriptions  became  more  extended  and  numerous,  and  the  therapeu- 
tical indications  more  precise.  They  became  convinced,  that  to  un- 
derstand diseases  well,  it  was  necessary  to  study  man  in  a  state  of  health. 
Thus  Anatomy,  or  the  knowledge  of  the  structure  of  the  human  body,  and 
Physiology,  or  the  knowledge  of  Organic  functions,  became  important 
branches  of  medical  science.  Experience,  also,  taught  men  that  it  is 
always  more  important,  and  often  easier,  to  prevent  the  development  of 
certain  diseases,  than  to  arrest  their  progress  when  once  developed. 
Consequently,  physicians  turned  their  attention  toward  this  object. 
They  traced  the  rules  for  the  preservation  of  health,  and  the  collection 
of  these  rules  constituted  a  new  branch  of  the  art  called  Hygiene.  These 
successive  additions  necessitated  a  change  in  the  definition  of  Medicine ; 
the  first,  not  embracing  any  longer  all  the  departments  of  the  science, 
the  following  was  then  nearly  unanimously  adopted  : 

"  Medicine  is  a  science  which  has  for  its  aim,  the  promotion  of  Health, 
and  the  cure  of  Disease." 

This  was,  for  a  long  time,  the  limit  of  the  Medical  horizon  ;  and  it 
can  not  be  doubted,  but  that  the  field  was  vast  enough  for  the  investiga- 
tions of  those  who  cultivated  it.  Nevertheless,  they  aspired  to  extend  it, 
so  constantly  does  the  genius  of  man  deride  the  limits  which  are  assigned 
to  it.  Two  interesting  ramifications  are  developed  recently,  from  this 
majestic  trunk  of  science  devoted  to  physical  man.  The  first,  named 
Orthopsedia,  teaches  how  to  correct  certain  exterior  deformities,  whether 
accidental  or  congenital ;  the  success  it  has  attained,  and  the  extension 
it  has  acquired,  make  it  already  a  special  branch  of  Medicine.  The 
second  ramification  is  called  Phrenology,  a  Greek  word,  which  signifies, 
literally,  a  discourse  on  thought,  or  on  the  faculties  of  the  soul.  But,  by 
thought,  here,  is  meant  the  organ  which  serves,  more  particularly,  for  its 
manifestation.  It  is  then  the  organ  of  thought,  that  is  to  say,  the  en- 
cephalon,  of  which  Phrenology  treats.  Those  who  have  made  a  special 
study  of  this  branch,  believe  that  the  development  of  the  faculties  of  the 
soul,  or  rather,  the  manifestation  of  these  faculties,  depends  on  the 
volume  and  the  form  of  certain  parts  of  the  encephalon.  They  hope  even 
to  determine,  by  the  exterior  examination  of  the  cephalic  box,  the  varia- 
tions in  the  volume,  and  the  form  of  the  brain,  and,  consequently,  the 
degree  of  development  of  its  faculties.      If   Phrenology  ever  realizes 


INTRODUCTION.  XI 

its  promises,  it  will  become  a  great  aid  to  the  physical  and  moral  educa- 
tion of  man.  However  this  may  be,  the  last  definition  that  we  have 
given  to  Medicine,  appears  to  me  a  little  too  restrained,  and  it  may  be 
advantageously  replaced.  I  think,  by  the  following : — "  Medicine  is  a 
Science,  which  aims  at  the  Preservation  of  Health,  the  cure  of  Diseases, 
and  the  Physical  perfection  of  Man." 

We  see  already,  by  this  simple  announcement,  what  Medical  Science 
strives  to  attain,  and  how  much  it  merits  the  attention  not  only  of  those 
who  make  it  a  special  study,  but  also  of  the  Philosopher,  the  Statesman, 
and  whoever  appreciates  the  advantages  of  good  health  as  well  as  the 
influence  of  the  physique  on  the  morale  of  man. 

To  the  historian,  Medicine  presents  itself  in  three  principal  phases, 
viz :  as  a  Profession,  as  an  Art,  and  as  a  Science. 

As  a  Profession,  Medicine  was  practiced,  primitively,  by  the  chiefs  of 
families,  of  tribes,  and  of  nations,  and  by  generals  and  legislators.  Af- 
terward, it  was  joined  to  the  Sacerdotal  office  for  a  very  long  time.  At 
last,  it  constituted  a  distinct  Profession,  which  was,  at  a  later  period,  sub- 
divided even  into  several  departments.  I  have  indicated,  summarily,  all 
these  revolutions,  with  the  circumstances  that  have  led  to  them,  and  the 
good  or  evil  consequences  that  have  resulted. 

In  the  point  of  view  of  an  Art,  that  is  to  say,  in  regard  to  the  rules 
which  have  been  established  at  divers  epochs  for  the  cure  of  diseases 
and  the  preservation  of  health.  Medicine  appears  to  me  to  have  followed 
a  constantly  progressive  march  from  its  origin  to  the  death  of  Galen. 
Then  it  remained  stationary,  or  even  retrograded,  at  least  in  Europe,  until 
the  end  of  the  fourteenth  century  of  the  Christian  era.  But  from  this 
epoch,  the  Healing  Art  took  a  new  bound,  and  acquired,  from  generation 
to  generation,  remarkable  perfection.  Those  who  deny  the  progress  of 
Medicine,  have  never  seriously  studied  its  history. 

If  it  is  true,  and  it  can  not  be  doubted,  that  Therapeutics  is  really  the 
essential  part  of  Medicine — if  it,  in  fact,  combines  all  the  advantages  of  the 
science,  it  can  not  be  questioned,  but  that  the  ancients  are  far  in  our  rear. 
To  prove  this,  it  is  sufficient  to  glance  at  any  class  of  diseases,  and  com- 
pare the  treatment  employed  formerly  with  that  of  our  times.  Exam- 
ine, for  example,  that  of  acute  diseases,  intermittent  fever,  apoplexy, 
most  of  the  anatomical  lesions,  the  prophylactic  treatment  for  variola, 
and  then  tell  me  if  the  therapeutics  of  the  ancients,  in  all  these  diseases, 
can  be  compared  with  that  of  the  moderns  !  The  same  I'esult  we  find  in 
regard  to  chronic  affections,  such  as  scrofula,  syphilis,  favus,  etc.  After 
this,  is  it  not  an  exhibition  of  ingratitude  or  ignorance  in  those  who  pretend 
that  ^Medicine  rests  stationary  in  the  midst  of  universal  progress  ?  But 
man  is  so  oblivious  of  benefits  he  has  received,  it  may  be  said  that  he 


Xll  rNTRODUCTION. 

has  a  memory  only  for  the  evils  he  has  suffered  !  The  storm  which  destroys 
in  an  instant  the  hope  of  the  laborer,  makes  an  ineffaceable  impression  on 
his  memory,  while  the  gentle  sprinkling  that  fructifies  his  furrow,  passes 
unperceivcd.  Thus  the  discovery  of  the  sulphate  of  quinia  has  made 
less  noise  in  the  world  than  that  of  the  congreve  rocket,  and  the  name 
of  Jenner  is  less  known  than  that  of  Attila ! 

As  a  Science,  so  far  as  regards  theories.  Medicine  offers  the  picture  of 
a  republic  delivered  up  to  many  rival  factions,  which  dominate  by  turns, 
without  ever  obtaining  lasting  power.  Theory  is  an  arena  of  intermin- 
able discussions,  a  real  tower  of  Babel ;  it  is  the  apple  of  discord  among 
physicians.  Who  can  flatter  himself  to  hold  the  equal  balance  among 
so  many  diverse  or  contrary  opinions,  to  distribute  equitably  praise  and 
blame;  to  mark  the  precise  limit  in  each  where  truth  ends  and  error 
commences? 

This  diiScult  enterprise  I  undertook,  not  with  a  view  of  instruct- 
ing others,  but  myself ;  not  with  the  intention  of  publishing  the  result  of 
my  research,  for  I  was  ignorant  what  it  would  be,  but  pressed  by  a 
desire  to  assure  myself  if  there  exists  in  Medicine  anything  useful 
and  certain,  any  principle  whose  evidence  is  striking  as  that  of  a  math- 
ematical axiom,  some  practical  rule  whose  utility  would  be  incontestable. 
I  think  that  a  physician  who  is  animated  with  a  sense  of  his  duty  can 
not  remain  indiftcrent  on  these  questions,  and  that  he  must  at  least  once 
in  his  life  examine  them  seriously.  If  something  of  this  kind  exist 
in  Medicine,  I  said  to  myself,  the  history  of  this  science  must  make  it 
apparent ;  and  consequently  I  embraced  with  ardor  and  perseverance 
the  study  of  this  history.  Now,  in  deciding  to  publish  the  result  of  my 
studies,  I  have  no  other  aim  than  that  of  saving  to  my  brethren  a  part 
of  the  labor  which  I  have  performed,  by  abridging  for  them  the  road  I 
had  to  travel. 

The  only  historian  who  has  attempted  to  unravel  the  chaos  of  medical 
theories  from  the  beginning  to  an  epoch  near  our  own  (Kurt  Sprengel,) 
has  arrived  at  this  conclusion — "  that  skepticism  in  Medicine  is  the  top 
stone  of  the  science,  and  that  it  is  the  wisest  part  to  regard  all  opinions 
with  indifference,  and  adopt  none."*  This  maxim  I  hold  to  be  erroneous, 
hopeless,  and  impracticable.  Xo,  whatever  this  erudite  historian  in 
Medicine  may  say,/loubt  is  not  the  last  word  of  science,  it  is  only  the  com- 
mencement of  it,  the  point  of  departure.  It  is  merely  a  favorable  dis- 
position for  acquiring  knowledge,  certainty,  or  at  least  conviction.  So 
taught  Aristotle,  so  proclaimed  Descartes,  and  the  intimate  sense  of  each 

^'  "  Hist,  de  la  Medicine,"  trad,  par,  A.  J.  L.  .Tourdan,  Paris,  1815,  t.  I,  Intro- 
duction pp.  10,  11.     See  also  the  "  Preface  du  Traductcur,"  p.  22,  et  suivantes. 


INTRODUCTION.  XIll 

one  of  us  confirms  the  same.  "When  we  undertake  the  search  for  truth, 
it  is  with  the  desire  and  hope  of  attaining  it,  and  if  persuaded  in  ad- 
vance that  this  desire  and  hope  are  vain,  (as  Sprengel  pretends,)  we 
would  rest  in  careless  repose,  rather  than  uselessly  fatigue  ourselves  in 
the  pursuit  of  a  chimera.  Nevertheless,  it  may  happen  that  our  inves- 
tigations will  only  produce  a  negative  result,  that  we  may  remain  in  the 
ignorance  and  doubt  whence  we  were  anxious  to  emerge ;  but  that  is  only 
an  accidental  or  particular  result,  not  the  general  or  necessary  one  at  which 
infallibly  all  human  researches  must  arrive.  We  are  ordinarily  con- 
ducted to  this  negative  conclusion  by  a  bad  method  of  reasoning,  in  the 
same  manner  that  a  false  road  conducts  the  traveler  far  from  the  true 
aim  of  his  journey. 

But  if  doubt  should  be  rigorously  maintained,  concerning  specula- 
tive truths,  it  must  not  be  so  in  relation  to  those  propositions  destined 
to  regulate  our  conduct.  In  regard  to  these,  we  are  constrained  to  take 
a  part  whether  we  will  or  no ;  in  other  words,  we  must  decide  upon 
some  conviction  more  or  less  strong.  A  j^hysiciau,  for  example,  may 
well  doubt,  when  in  his  cabinet,  if  the  difficulty  of  respiration  realized 
by  an  asthmatic,  proceeds  from  a  lesion  of  the  heart,  or  great  vessels,  or 
from  an  accumulation  of  mucus,  or  from  a  rheumatic  condition  of  the 
muscles,  or,  lastly,  from  the  nerves  of  the  chest.  But  this  physician 
once  in  the  presence  of  his  patient,  after  having  examined  him,  will  be 
obliged  to  make  a  pi-escription.  Can  there  be  for  him  any  possible 
choice  between  doing  something  or  nothing  ?  Now,  if  he  orders  nothing, 
does  he  not  so  conclude  from  an  opinion  ?  and  he  does  the  same  if  he 
prescribes ;  the  choice  of  doing  nothing  or  something,  supposes  a  motive 
more  or  less  strong.  Pure  skepticism,  then,  is  impossible  in  a  practi- 
tioner who  each  day  finds  himself  placed  in  the  necessity  of  making  a 
decision  on  which  will  depend,  perhaps,  the  life  of  his  fellow-man.  A 
practitioner  can,  therefore,  not  indulge  in  the  skeptical  indifiereuce  of 
which  the  historian  I  have  cited,  boasts ;  he  must,  on  the  contrary,  use 
every  effort  to  free  himself  from  it,  and  rise  to  the  point  of  rational 
conviction. 

It  is  with  this  disposition  of  mind  that  I  have  undertaken  the  exam- 
ination of  ancient  and  modern  medical  doctrines.  I  have  studied  and 
compared  them  with  all  the  attention  of  which  I  am  capable ;  for  I  wished 
to  form  an  opinion  based  on  the  absolute  or  relative  value,  on  the  advan- 
tageous or  injurious  influence,  of  each  one  of  them.  The  reader,  then, 
must  not  be  astonished  if,  in  the  course  of  this  history,  I  emit  often  and 
in  a  very  explicit  manner,  my  own  opinion  on  the  theories  under  consid- 
eration. But,  in  fine,  that  the  reader  may  be  in  a  condition  to  appreciate 
for  himself  these  theories,  and  the  judgment  that  I  form  of  them,  I  shall 


XIV  INTRODUCTION. 

present  them  with  all  the  exactness  I  possibly  can,  employing  for  this 
purpose,  the  text  even  of  the  authors  who  have  written  in  our  own  language, 
and  that  of  the  translations  of  the  most  esteemed  foreign  authors.  I 
shall  not  pretend  to  translate  them  myself,  except  in  cases  where  no  trans- 
lation has  been  made.  I  act  thus,  in  the  persuasion  that  a  man  who 
makes  a  particular  and  profound  study  of  a  work,  translating  it  entire, 
must  be  penetrated  with  the  spirit  of  the  author  much  better  than  he 
who  extracts  from  it  a  few  pages  only.  Beside,  I  hope  by  this  method 
to  avoid  the  reproval  of  misrepresenting  the  opinions  of  others,  either 
unknowingly  or  by  design,  and  so  preserve,  as  far  as  I  am  concerned, 
their  color  and  original  forms. 

Celebrated  physicians  influence  the  progress  of  their  Science  and  the 
value  of  their  Art,  not  by  their  writings  only,  but  by  their  oral  teach- 
ings, character,  and  conduct.  Their  lives  offer,  often,  models  for  imita- 
tion, and  sometimes,  also,  faults  and  errors  to  be  avoided.  Often. 
too,  the  early  education  of  a  man,  and  the  circumstances  in  the  midst 
of  which  he  was  reared,  explain  the  peculiarity  of  his  genius,  and  give 
the  key  to  his  successes  and  reverses.  For  these  reasons,  I  could  not 
neglect  entirely  some  biographic  details  relative  to  the  most  famous 
physicians,  especially  when  these  details  had  some  connection  with  the 
general  history  of  the  Art,  or  embraced  some  moral  considerations. 

The  sciences  do  not  pursue  their  march  isolated  from  each  other,  they 
go  hand  in  hand,  and  it  is  rare  that  their  progress  is  not  simultaneous. 
An  exception  to  this  rule,  however,  presents  itself  in  the  history  of  the 
human  mind  in  Europe.  During  the  middle  ages,  dialectics  and  the- 
ology are  cultivated  successfully,  while  the  other  branches  of  human 
knowledge,  and  Medicine  in  particular,  merely  vegetate  in  deep  neglect. 
But  with  the  fourteenth  century,  industry,  the  sciences,  and  the  arts, 
awake  from  their  long  sleep. 

On  the  one  hand,  the  civil  and  political  organization  of  European 
nations  becomes  regulated,  their  material  good  increases ;  on  the  other, 
the  intellectual  and  moral  faculties  of  individuals  are  developed — the 
mind  makes  efforts  freer,  bolder,  and  in  a  better  direction.  The  histo- 
rian of  Medicine  would  fail,  it  seems  to  me,  in  one  of  his  duties,  if  he 
did  not  now  and  then  give  a  general  view  of  the  state  of  society. 
Therefore,  at  the  commencement  of  each  of  my  Chronological  divisions, 
I  give  a  rapid  sketch  of  the  aspect  which  civilization  then  presented. 

Another  fact  extremely  remarkable,  and  of  capital  interest  in  the  his- 
tory of  medical  theories  is,  that  they  are  all  derived  more  or  less  direct- 
ly, from  some  system  of  philosophy ;  so  that  only  an  incomplete  idea 
of  them  could  be  obtained  if  the  philosophic  sources  from  which  they 
were  drawn  were  unknown.     But  too  much  importance  must  not  be 


INTRODUCTION.  XV 

attached  to  these  analogies,  nor  must  the  value  of  medical  theories  be 
judged  bj  them.  It  must  not  be  forgotten  that  a  philosophic  system 
may  be  false  as  a  whole,  and  yet  true  in  its  particular  application  to 
Medicine.  On  the  other  hand,  we  may,  by  false  logic,  deduce  an  erro- 
neous medical  theory  from  an  iri'eproachable  philosophic  system.  Thus, 
then,  after  having  indicated  the  philosophic  ideas  with  which  each  medi- 
cal doctrine  may  seem  to  be  related,  we  shall  judge  this  in  itself,  and 
relative  to  its  practical  consequences. 

The  principal  systems  of  antiquity  concerning  Cosmogony,  or  general 
physics,  may  be  ranged  in  three  sections,  as  follows : 

1.  Those  that  have  at  their  head  Pythagoreanism — representing  the 
universe  as  inhabited  by  active  and  intelligent  principles,  which  ani- 
mate, fashion,  and  govern  each  material  substance  in  a  determinate  way, 
and  for  a  preconceived  end.  The  animals,  plants,  and  even  minerals, 
possess,  each,  a  vivifying  spirit.  Above  these  secondary  principles  rules 
the  Supreme  principle,  who  superintends  the  whole,  harmonizing  indi- 
vidualities, and  causing  them  to  concur  to  one  common  end. 

2.  Another  class  of  philosophers,  of  whom  Leucippus  and  Democritus 
seem  to  be  the  chiefs,  considered  the  formation  of  the  universe  as  a  pure 
result  of  chance.  They  pretend  to  explain  all  the  phenomena  of  nature 
without  having  recourse  to  the  intervention  of  any  intelligent  principle. 
According  to  them,  the  world  in  general,  and  each  being  in  particular, 
exists  as  a  necessary  result  of  the  eternal  laws  of  matter.  They  deny 
that  different  substances,  such  as  plants  and  animals,  were  created  for  a 
preconceived  end.  They  ridicule  what  was  termed  in  the  language  of 
philosoph}-,  final  causes. 

Finally,  a  third  sect,  which  recognizes  Parmenides  and  Pyrrho  as  their 
founders,  who,  believing  that  there  exist  in  the  natural  movement  of  bodies, 
in  their  reproduction  and  endless  changes,  motives  equally  powerful  to 
admit  or  reject  the  presence  of  immaterial  and  intelligent  principles,  con- 
cluded, from  this  ambiguity,  that  wisdom  consists  in  remaining  in  doubt. 
"  What  is  the  use,"  say  those  sectators,  "  of  fatiguing  the  mind  in 
efforts  to  comprehend  what  is  beyond  its  capabilities  ?  The  research  after 
principles  or  first  essences,  has  only  resulted,  thus  far,  in  useless  and  in- 
terminable disputes.  We  receive  no  real  knowledge  but  through  our 
sensations,  and  we  have  no  certainty  in  these  beyond  the  objective  ex- 
actitude." Such  was,  in  short,  the  language  of  this  sect,  which  sometimes 
took  the  name  of  Skeptic,  to  designate  the  perpetual  doubt  which  they 
professed,  and  sometimes  that  of  Zetetic,  to  indicate  that  they  were 
always  in  search  of  truth,  without  flattering  themselves  to  have  found  it. 
To  these  three  systems  of  Philosophy  among  the  ancients,  correspond 


XVI  INTRODUCTION. 

three  systems  of  Medicine,  of  which  I  shall  merely  indicate,  now,  the  prin- 
cipal traits. 

The  first  of  all,  known  by  the  name  of  Dogmatism,  is  attributed  to 
Hippocrates,  its  culminating  idea  being,  that  "  there  is  a  simple  principle 
and  multiple  in  its  eflfects,  that  presides  over  the  body  and  all  its  func- 
tions, creating  contraries,  and  vivifying  the  whole  and  each  part." — 
(Hippocr.,  de  V Aliment,  §  7.)  This  idea  is  reproduced  many  times  in 
the  same  work,  and  in  others  also,  by  the  same  author.  It  is  the 
foundation  of  Vitalism,  or  modern  Hippocratism,  a  doctrine  that  M. 
Professor  Cayol  has  explained  in  so  lucid  a  manner,  in  his  introduction 
to  the  "  Medical  Clinic,"  and  which  M.  Gibert  has  sustained  with  all 
the  vigor  and  logic  for  which  he  is  distinguished." 

One  of  the  most  celebrated  nosologists  of  the  last  age,  Pinel,  has 
given  an  idea  of  disease  conformable  to  this  doctrine,  when  he  says: 
"  Disease  should  be  considered,  not  as  a  tableau  always  in  motion, 
an  incoherent  assemblage  of  recurring  affections  that  are  unceasingly  to 
be  combated  by  remedies,  but  as  an  indivisible  unit,  from  its  beginning 
to  its  termination — a  regular  totality  of  characteristic  symptoms,  and 
succession  of  periods  with  a  natural  tendency,  most  frequently  favorable, 
though  sometimes  fatal,  "f 

This  definition,  which  presents  disease  to  us  as  a  regular  succession 
of  actions  and  movements  sustained  by  the  vital  principle  with  a  man- 
ifest purpose,  shows  already  the  connection  that  exists  between  the  doc- 
trines of  Hippocrates  and  the  Pythagorean  philosophy;  but  this 
connection  becomes  more  and  more  striking  by  the  details  which  will  be 
given  hereafter,  in  the  course  of  this  history.  For  it  would  be  a  great 
error  to  suppose  that  the  passages  above  quoted  are  a  resume  of  the 
entire  medical  theory  of  the  physician  of  Cos.  They  must  only  be 
considered  as  one  of  the  principal  phases  of  his  theory — one  of  its  char- 
acteristic dogmas — the  only  one  which  has  maintained  its  place  down 
to  our  times. 

The  second  system  which  is  ofiered  for  our  examination  has  received 
the  name  of  Methodism,  and  recognizes  as  its  founders,  Asclepiades  and 
Themison.  The  former  studied,  with  great  care,  chronic  diseases,  in  which 
the  medicative  force  of  nature  is  often  imperceptible.  He  felt  justified 
in  denying  the  existence  of  this  force,  and  turned  into  ridicule  the  Hip- 
pocratic  dogmas  on  this  subject.     On  the  other  hand,  seduced  by  the 


^  "  Considerations  sur  I'llippocratisme  et  I'Anatomisme."    Paris,  1833,  in  8. 
I "  Nosogr.  Philosophique."     1st  edition,  Introduction,  p.  7. 


INTRODUCTION.  XVll 

Atomic  theory  of  Democritus,  which  Epicurus  had  developed  and  rejuve- 
nated, he  hastened  to  make  an  application  of  it  to  Medicine.  He  repre- 
sented the  human  body  as  pierced  by  an  infinity  oi  pores,  through  which 
the  atoms  of  various  forms  and  sizes  must  pass  and  repass  without  ces- 
sation. These  corpuscles,  excessively  attenuated,  were  supposed  to 
move  about  automically,  in  virtue  of  the  inherent  force  of  matter.  As 
long  as  the  s'ze  and  form  of  these  atomic  corpuscles  were  in  exact  pro- 
portion to  the  passage  through  which  they  had  to  move,  was  the  health 
of  the  individual  maintained.  But  as  soon  as  the  exactness  of  these 
relations  was  destroyed,  the  health  was  deranged ;  but  this  could  only 
occur,  says  this  physician,  in  two  ways,  viz :  either  by  an  excessive  con- 
traction or  dilatation  of  the  pores.  In  this  system,  the  animal  economy 
is  regarded  as  entirely  passive ;  no  reaction,  no  spontaneity,  no  natural 
tendency  whatever  is  attributed  to  it.  The  physician  had  but  to  direct 
the  movement  of  the  economy  by  means  of  modifying  agents  which  art 
placed  at  his  disposal. 

The  two  preceding  systems,  as  is  plainly  seen,  were  diametrically  oppo- 
site ;  the  one  never  lost  sight  of  the  natural  activity  of  the  organism  in 
diseases ;  the  other  considered  the  human  body  as  in  a  passive  state 
only.  But  if  pathological  phenomena  are  observed  without  prejudice,  it 
soon  becomes  evident  that  in  the  production  of  these  phenomena,  the 
organism  is,  by  turns,  both  active  and  passive.  Thus,  when,  from  the 
infliction  of  a  severe  wound,  general  symptoms  appear,  such  as  fever, 
delirium,  and  convulsions,  it  is  evident  that  under  these  circumstances 
the  organism  is  at  once  active  and  passive ;  passive,  in  relation  to  the 
local  lesion,  the  pain,  and  the  shock  experienced ;  active,  relatively  to 
the  general  functional  derangement  which  is  an  effect  of  the  vital  reac- 
tion. If  I  may  be  permitted  to  make  use  of  a  vulgar  illustration,  bor- 
rowed from  antiquity,  to  show  the  double  action  of  the  animal  economy 
in  the  production  of  morbid  phenomena,  I  will  simply  refer  to  the  ser- 
pent, which,  biting  his  own  tail,  is  simultaneously  the  cause  and  the  object 
of  the  action. 

The  Dogmatists  did  not  deny  that  the  organism  is  passive  at  the  moment 
when  it  receives  the  impression  of  a  nosogenic  influence ;  but  they 
regarded  this  impression  as  a  simple  occasional  cause ;  they  pretended  that 
the  disease  only  commences,  really,  with  the  reaction  of  the  vital  prin- 
ciple. This  reaction,  according  to  them,  is  the  primitive  and  essential 
phenomenon,  the  proximate  or  occult  cause  of  the  morbid  affection. 

The  Methodists,  on  the  contrary,  considered  vital  reaction  as  a  sec- 
ondary phenomenon,  a  species  of  oscillatory  change,  of  which  the  proxi- 
mate or  primitive  motor  cause  was  the  impulsion  produced  by  the 
morbific  agent. 


XVlll  INTRODUCTION. 

A  third  class  of  physicians,  at  the  head  of  which  it  has  been  cus- 
tomary to  place  Philinus  and  Serapis,  thinking  that  the  proximate  cause. 
or  the  primitive  phenomena  of  diseases,  was  inaccessible  to  observation, 
hence  concluded  that  all  which  was  affirmed  on  that  subject,  is  arbitrary, 
hypothetical,  and  unworthy  of  consideration  in  the  choice  of  a  rational 
treatment.  They  asked  that  in  the  description  and  treatment  of  dis- 
eases, only  such  symptoms  should  be  recorded  as  fall  under  the  notice  of 
our  senses.  The  totality  of  these  phenomena  constituted,  in  their  eyes. 
the  whole  morbid  aflfection,  or  at  least  all  that  could  be  known  or  affirmed 
in  regard  to  it. 

Consequently,  they  assumed,  that  in  any  given  case,  only  such  reme- 
dies as  had  appeared  to  be  valuable  in  similar  cases,  should  be  employed, 
without  any  regard  to  the  proximate,  essential,  or  occult  cause,  of  which, 
they  say,  nothing  reveals  to  us  the  mode  of  action.  As  their  reasoning 
did  not  go  beyond  those  things  which  have  already,  or  may  yet  become 
matters  of  observation  and  experience,  they  took  the  name  of  empirics, 
which  signifies  experimenters.  They  have  been  classed  with  the  skeptical 
philosophers,  who  place  nothing  in  the  rank  of  certain  and  positive 
knowledge,  but  the  sensations. 

A  considerable  number  of  physicians  would  not  adopt  any  of  these 
systems,  exclusively,  but  drew  from  each  what  to  them  seemed  to  be 
most  conformable  to  reason  and  experience.  They  called  themselves 
Eclectics,  from  a  Greek  word,  which  signifies,  to  choose ;  by  which  they 
wish  to  imply,  that  they  made  a  rational  choice  of  what  appeared  to  be 
best,  of  all  doctrines.  It  must  be  admitted,  that  this  is  a  very  laudable 
design,  though  somewhat  pretentious.  They  should,  however,  have  indi- 
cated the  I'ule  by  which  they  were  guided  in  this  choice,  what  principle 
they  followed  in  discerning,  among  so  many  contradictory  opinions, 
truth  from  error,  the  reality  from  fallacy,  and  the  good  from  evil. 

This  is  what  the  Eclectics  ought  to  have  been  able  to  do,  but  what 
they  have  not  done.  They  contented  themselves  by  affirming  that  they 
followed,  in  every  case,  the  voice  of  experience  and  of  reason,  without 
permitting  themselves  to  be  influenced  by  any  prejudice,  or  systematic 
idea.  But  we  must  take  their  word  for  it,  for  they  have  emitted  no 
axiom  which  enables  us  to  see  it  for  ourselves.  Eclecticism  is,  in  reality, 
neither  a  system  nor  a  theory ;  it  is,  uniquely,  an  individual  pretension, 
elevated  to  a  dogma.  Each  Eclectic  recognizes  no  other  rule,  than  his 
particular  taste,  his  individual  reason,  or  his  fancy.  Two,  so  called, 
Eclectics  have  seldom  anything  in  common,  but  the  name. 

The  Eclectic  carefully  avoids  the  discussion  of  principles.  He  has 
little  taste,  or  little  capacity  for  high  abstractions.  He  believes  them 
useless,  not  to  say  injurious  to  the  practice  and  progress  of  the  art.    In 


INTRODUCTION.  XIX 

a  word,  the  assumption  of  the  name  of  Eclectic  conveys  a  very  unfavor- 
able idea  as  to  the  iixity  of  their  philosojjhic  principles.  But  the  Eclec- 
tic may  be,  and  often  is  indeed,  a  good  practitioner.  If,  on  the  one 
hand,  he  disregards  the  fundamental  principles  of  science,  on  the  other 
he  concentrates  his  attention  on  details ;  and  we  all  know  that  practical 
skill  is  based,  particularly,  on  specialties.  To  such  may,  with  good 
reason,  apparently,  be  applied  the  proverb,  "good  practitioner,  bad 
theorist."  Not  that  he,  necessarily,  has  no  theoretic  ideas ;  that  is  im- 
possible :  but  his  ideas  form  no  system,  and  are  not  based  upon  general 
principles.  AVith  him,  medical  tact,  that  is,  cultivated  instinct,  takes 
the  place  of  principles.  Such  was  the  erudite  Barckauscn,  who,  in 
reviewing  medical  theories,  found  in  all,  something  to  blame,  and  some- 
thing to  praise,  without  giving  to  any  one  a  marked  preference. 

The  Eclectic  of  our  times  is,  ordinarily,  only  an  empiric  in  disguise : 
but  an  empiric,  in  an  honorable  sense  of  that  term ;  that  is  to  say,  a 
man  whose  opinions  are  based  on  the  pure  and  simple  observation  of 
facts,  carefully  compared ;  whose  theoretical  ideas  do  not  go  beyond 
phenomena.  In  order  to  form  a  system,  his  ideas  only  need  to  be  united 
by  a  common  tie,  under  the  guidance  of  a  philosophic  principle. 

I  have  just  expressed  the  idea  that  it  is  impossible  for  a  man  to  prac- 
tice Medicine  without  any  species  of  theory.  This  is  an  axiom  which 
has  no  need  of  demonstration,  says  Professor  Bouillaud." 

Doctor  Auber  unites  in  this  opinion.  '"Be  well  convinced,"  says  he. 
"  of  one  thing,  that  there  is  no  practitioner  who  has  not,  however  lim- 
ited, his  theory,  and  who  may  not,  also,  be  carried  away  by  it  at  the  bed- 
side, seeing  that  it  is,  necessarily,  by  reason  of  some  idea,  false  or  true. 
wise  or  foolish,  scientific  or  vulgar,  that  even  the  most  senseless  physi- 
cian determines,  or  is  compelled  automatically,  to  act  in  one  way  rather 
than  in  any  other,  and  on  this  account  it  is  said,  with  infinite  reason, 
that  the  practice  must  ever  submit  to  the  yoke  and  exigencies  of  even 
the  most  contemptible  theories." — ("  Traite  de  la  Philosophic  3Iedicale.'' 
Paris,  1839,  p.  185.) 

To  those  readers  who  may  accuse  me  of  attaching  too  much  importance 
to  the  examination  of  theories,  I  must  respond, — theories  have  been,  and 
will  forever  be,  the  compass  of  the  practice. 

Anciently,  philosophy  embraced  the  whole  of  human  knowledge, 
physics,  natural  history,  medicine,  morals,  metaphysics,  theology,  math- 
ematics, etc.  The  philosopher  was  not  pcrmittc^  to  be  unacquainted  with 
any  of  them.     Now,  physics,  natural  history,  medicine,  and  many  other 

*  "  Essai  sur  la  Philosophie  Medicale  et  sur  les  Generalites  de  la  Clinique  Med- 
icale."    Paris,  1836,  page  302. 


XX  INTRODUCTION. 

branches  of  philosophy  have  been  detached  from  the  main  trunk,  and 
constitute  separate  sciences.  From  this  separation,  it  results  that  mod- 
em Medicine  has  borrowed  less  from  philosophy,  propei'ly  so  called ;  but 
in  compensation,  it  has  been  influenced  by  other  sciences,  such  as  physics 
and  chemistry. 

From  the  end  of  the  fourteenth  century  of  our  era,  to  the  commence- 
ment of  the  nineteenth,  we  count,  in  ]\Iedicine,  five  classes  of  principal 
theories,  namely :  the  ancient  Humoralism  or  Galenism,  the  latro-Chem- 
ical,  the  latro-Mechanical,  Animism  or  Vitalism,  which  is  confounded 
with  modern  Hippocratism,  and  finally,  Organo-Dynamism. 

I  shall  not  extend  further  these  general  considerations,  or  I  should 
encroach  on  what  will  be  said  in  the  course  of  this  history,  where  the 
theories  to  which  I  have  alluded,  and  some  less  important  ones,  will  be 
properly  treated. 

The  following  is  the  chronological  order  which  I  have  thought  it 
proper  to  adopt:  I  divide  into  three  Books,  or  three  Ages,  all  past 
time.  The  First  Age  commences  with  the  infancy  of  society,  as  far 
back  as  historic  tradition  carries  us,  and  terminates  toward  the  end 
of  the  second  century  of  the  Christian  era.  at  the  death  of  Galen, 
during  the  reign  of  Septimus  Severus.  This  lapse  of  time  constitutes, 
in  Medicine,  the  Foundation  Age.  The  germ  of  the  Healing  Art,  con- 
cealed, at  first,  in  the  instincts  of  men,  is  gradually  developed  ;  the  basis 
of  the  science  is  laid,  and  great  principles  are  discussed.  The  human 
mind,  always  impatient,  surpasses  in  its  speculations,  the  limits  of  the 
known  and  possible.  Many  branches  of  the  art,  such  as  Symptomatol- 
ogy and  Prognosis,  are  carried  to  a  remarkable  degree  of  perfection. 

The  Second  Age,  which  may  be  called  the  Age  of  Transition,  offers  very 
little  material  to  the  history  of  Medicine.  We  sec  no  longer  the  con- 
flicts and  discussions  between  partisans  of  different  doctrines ;  the  medi- 
cal sects  are  confounded.  The  art  remains  stationary,  or  imperceptibly 
retrogrades.  I  can  not  better  depict  this  epoch  than  by  comparing  it 
to  the  life  of  an  insect  in  the  nympha  state ;  though  no  exterior  change 
appears,  an  admirable  metamorphosis  is  going  on,  imperceptibly,  within. 
The  eye  of  man  only  perceives  the  wonder  after  it  has  been  finished. 

Thus,  from  the  fifteenth  century,  which  is  the  beginning  of  the  third 
and  last  Age  of  Medicine,  or  the  Age  of  Renovation,  Europe  offers  us  a 
spectacle  of  which  the  most  glorious  eras  of  the  republics  of  Greece 
and  Rome  only  can  give  us  an  idea.  It  would  seem  as  if  a  new  life  was 
infused  into  the  veins  of  the  inhabitants  of  this  part  of  the  world ; 
the  sciences,  fine  arts,  industry,  religion,  social  institutions,  all  are 
changed.  A  multitude  of  schools  are  opened  for  teaching  jMedicine. 
Establishments  which  had  no  models  among  the  ancients,  are  created 


INTRODUCTION.  XXI 

for  the  purpose  of  extending  to  the  poorer  classes  the  benefits  of  the 
Healing  Art.  The  ingenious  activity  of  modern  Christians  explores 
and  is  sufiicient  for  everything. 

These  three  grand  chronological  divisions  do  not  suffice  to  classify,  iu 
our  minds,  the  principal  phases  of  the  history  of  Medicine ;  conse- 
quently, I  have  subdivided  each  age  into  a  smaller  number  of  sections, 
easy  to  be  retained,  and  which  I  have  named  Periods.  The  first  Age 
embraces  four  periods,  the  second  and  third  ages,  each,  two. 

I  will  now  indicate  succinctly,  each  of  these  secondary  divisions, 
without  attempting,  at  present,  to  justify  them,  for  this  will  be  done  in 
its  proper  place  in  the  course  of  the  work. 

The  first  period,  which  we  name  Primitive  Period,  or  that  of  Instinct, 
ends  with  the  ruin  of  Troy,  about  twelve  centuries  before  the  Christian 
era. 

The  second,  called  the  Mystic  or  Sacred  Period,  extends  from  the 
dissolution  of  the  "  Pythagorean  Society  "  to  about  the  year  500,  A.  C. 

The  third  period,  which  ends  at  the  foundation  of  the  Alexandrian 
Library,  A.  C,  320,  we  name  the  Philosophic  Period. 

The  fourth,  which  we  designate  the  Anatomic,  extends  to  the  end  of 
the  first  age,  i.  e.,  to  the  year  200  of  the  Christian  era. 

The  fifth  is  called  the  Greek  Period ;  it  ends  at  the  destruction  of  the 
Alexandrian  Library,  A.  D.  640. 

The  sixth  receives  the  surname  of  Arabic,  and  closes  with  the  four- 
teenth century. 

The  seventh  period,  which  begins  the  third  age,  comprises  the  fifteenth 
and  sixteenth  centuries ;  it  is  distinguished  as  the  Erudite. 

Finally,  the  eighth,  or  last  period,  embraces  the  seventeenth  and 
eighteenth  centuries.     I  call  it  the  Eeform  Period. 

In  this  division  of  the  past,  there  is  wanting  that  portion  of  the 
nineteenth  century  which  has  already  passed.  I  have  omitted  it  for 
the  following  reasons :  First — I  have  asked  myself,  is  it  possible  to 
write  cotemporaneous  history  with  the  same  independence  of  mind  as 
that  of  the  past?  Secondly — Is  it  suitable,  in  speaking  of  living 
authors,  to  omit  all  biographic  details  ?  Thirdly — Is  there  not  dan- 
ger of  exaggerating  cotemporaneous  opinions  and  discoveries  ?  Lastly — 
Can  we  seize  the  general  physiognomy  of  an  epoch  while  living  in  its 


XXll  INTRODUCTION. 

midst  ?  Does  not  one  in  such  a  position  resemble  a  man  who,  placed 
at  the  foot  of  an  edifice,  thinks  himself  capable  of  appreciating  the 
effect  of  the  whole  structure  ? 

All  these  considerations,  have  led  me  to  fear  that  I  could  not  trace 
the  history  of  our  own  times  after  the  same  plan  as  that  of  the  history 
of  the  past,  and  I  have  therefore  taken,  as  my  limit,  the  end  of  the 
eighteenth  century. 

I  propose,  however,  to  give  hereafter,  under  the  title  of  Materials  for 
Cotemporaneous  Medical  History,  a  discussion  of  the  theories,  discov- 
eries, and  improvements  that  have  signalized  the  first  half  of  the  pres- 
ent century.     This  will  form  a  supplement  to  the  second  volume.'-' 

*'See  Appendix. 


SYNOPTIC    TABLE 


OF  THE  AGES  AXD  PERIODS  OF 


THE   HISTOEY   OF   MEDICIIVE 


f  I.  Pruiitive  Period,  or      Ending  with  the  destruction  of 
that  of  Instinct.  Troy,    1184    years    before 

Christ. 


Age  of  Foundation,  " 


II.  Sacred,  or 

Mystic  Period. 


Ending  at  the  dispersion  of  the 
Pythagorean  Society,  500 
years  before  Christ. 


III.  Philosophic  Period.    Ending  at  the  foundation  of  the 

Alexandrian  Library,   320 
years  before  Christ. 

IV.  ANATOinc  Period.        Ending  at  the  death  of  Galen, 
V  A.  D.  200. 


/  Y.  Greek  Period. 


Age  of  Transition,  -< 


VI.  Arabic  Period. 


Ending  at  the  burning  of  the 
Alexandrian  Library,  A.  D. 
640. 

Ending  at  the  revival  of  letters, 
A.  D.  1400. 


Age  of  Renovation, 


/  VII.  Erudite  Period.         Comprising  the  XV.  and  XVI. 

centuries. 

VIIT.  Reform  Period.         Comprising    the     XVII.     and 
XVIIl.  centuries. 


HISTOEY  OF  MEDICINE. 


BOOK      I. 
AGE   OF   FOUNDATION. 

EXTENDING   FROM   THE,  ORIGIN    OF   SOCIETY   TO    THE    END  OF  THE. 
SECOND  CENTURY  OF  THE  CHRISTIAN  ERA. 


I     PRIMITIVE   PERIOD. 

OF  VARIABLE   DURATION   AMONG   DIFFERENT  PEOPLE. 
GENERAL     CONSIDERATIONS. 

This  period,  which  corresponds  with  the  early'infancy  of  human  society, 
is  enveloped  in  profound  obscurity,  and  mingled  with  a  multitude  of 
fables  It  embraces  an  indefinite  lapse  of  time,  during  which,  Medicine, 
did  not  constitute  a  Science,  that  is  to  say,  a  systematic  assemblage  of 
rational  knowledge,  but  formed  rather  an  undigested  collection  of  ex- 
perimental notions,  vaguely  described,  and  more  frequently  disfigured  by 
a  series  of  incomplete  traditions.  It  is  easily  understood,  that  such  a 
state  of  things  must  have  existed,  a  longer  or  shorter  time,  in  difi"erent 
parts  of  the  globe,  in  proportion  to  the  progress,  more  or  less  rapid; 
that  the  inhabitants  of  those  parts  made  in  the  career  of  civilization. 
This  state  of  things  still  exists  among  certain  tribes  in  the  center  of 
Africa,  in  some  parts  of  America,  and  especially  in  Oceanica.  But  for 
Grreece,  which  has  transmitted  to  us  the  most  precious  memorials  of 
antique  Medicine,  the  Primitive  Period  ended,  as  we  shall  see  further  on, 
at  the  destruction  of  Troy,  in  the  course  of  the  twelfth  century  before 
the  Christian  era. 
2 


26  PKIMITIVE   PERIOD. 

Before  following  the  trace  of  the  Art  of  Healing,  on  the  classic  ground 
of  the  Hellenists,  we  shall  seek  the  first  vestiges  of  it  among  other 
nations  that  preceded  the  hellenic  nation,  on  the  route  of  social  progress, 
and  who  furnished  it,  in  those  remote  times,  models,  in  more  than  one 
sense.  Consequently,  we  shall,  in  the  first  place,  cast  a  glance  at  the 
antique  Medicine  of  the  Egyptians,  the  Jews,  the  Indians  and  the 
<-.hinese ;  then  we  shall  describe  the  state  of  Greek  Medicine,  before  the 
Trojan  war,  and  finally  say  a  few  words  on  the  manner  in  which  this 
Art  was  cultivated,  primitively,  among  some  nations  less  celebrated,  both 
in  the  Old  and  New  World. 


CHAPTER    I. 
MEDICINE    OF    THE    ANTIQUE   NATIONS. 

I.    MEDICINE  OF  THE  EGYPTIANS. 

If  we  accord  the  first  place,  in  this  history,  to  Egyptian  Medicine,  it  is 
not  without  a  motive.  It  seems  to  us  to  merit  this  honor,  not  only 
because  its  antiquity  is  based  on  monuments,  the  most  authentic,  but 
also  because  it  has  been  the  source  whence  the  Greeks  drew  the  first 
elements  of  this  science;  and  in  this  respect  also  the  Egyptian  nation 
may  be  justly  named,  the  instructress  of  the  human  race.  We  read  in 
the  Bible,  that  when  Jacob  died,  "Joseph  commanded  his  servants,  the 
physicians,  to  embalm  him ;  and  the  physicians  embalmed  Israel,  and 
forty  days  were  fulfilled  for  him,  for  so  are  fulfilled  the  days  of  those 
that  are  embalmed."  (Gen.  chap.  1.)  Thus,  at  the  death  of  the  Patri- 
arch Jacob,  about  1700  years  before  the  birth  of  Christ,  Egypt  possessed 
men  who  practiced  the  art  of  medicine.  This  passage,  in  the  writings  of 
Moses,  is  the  most  ancient  authentic  monument  that  we  possess  of  the 
Healing  Art ;  all  that  is  more  remote  in  the  history  of  Egypt,  and  of 
other  nations,  is  enveloped  in  uncertainty  and  obscurity,  at  least  so  far 
.as  medicine  is  concerned. 

Nevertheless,  it  is  certain,  that  before  the  time  of  the  emigration  of  the 
■sons  of  Jacob  to  Egypt,  the  arts  and  sciences  had  already  attained,  in  that 
country,  a  degree  of  perfection  which  could  only  be  the  result  of  long 
experience,  that  required  very  many  years  or  rather  centuries  of  obser- 
vation. The  books  of  the  Hebrews,  furnish  other  more  valuable  infor- 
mation on  this  subject.  We  read  in  them,  that  when  Abraham  was 
constrained  by  the  famine,  to  quit  the  land  of  Canaan,  he  entered  Egypt, 
where  he  found  an  abundance  of  everything  to  nourish  his  household 
and  his  flocks.     At  this  epoch,  which  preceded  the  death  of  Jacob  230 


MEDICINE   OF  THE  EGYPTIANS.  27 

years,  Egypt  rejoiced  in  a  very  advanced  state  of  civilization.  Agricul- 
ture, Geometry,  Architecture,  Metallurgy,  had  all  then  made  a  remark- 
able progress.  Thebes,  the  city  of  a  hundred  gates,  existed  as  well  as 
some  of  those  gigantic  edifices,  destined  to  transmit  to  posterity, 
the  evidence  of  the  power  and  wisdom  of  the  Pharoahs.  •■^ 

But  through  how  many  phases  must  the  Egyptian  nation  have  passed, 
before  its  intelligence  and  industry  had  acquired  such  a  development ! 
How  many  centuries  must  have  run  by.  before  her  men  possessed  the 
means  of  perpetuating  the  memory  of  great  events  and  useful  inventions ! 
The  arts  of  speaking  and  writing,  these  two  indispensable  instruments  for 
the  transmission  of  ideas,  how  were  they  created  ?  By  what  series  of 
gradual  improvements  did  they  arrive  at  that  point  of  clearness,  requi- 
site to  produce  exactly  the  image  of  the  thoughts?  The  most  ar- 
duous and  subtle  researches,  teach  us  nothing,  or  next  to  nothing  on  these 
interesting  questions ;  the  science  of  Champollion  is  mute  on  this  point ; 
the  sacred  books  alone  clear  up  this  difficulty,  in  saying  that  God 
taught  to  man,  the  names  of  all  animate  and  inanimate  things. 

So  then,  the  generations  that  have  bestowed  upon  the  human  race  the 
most  useful  discoveries,  have  themselves  passed  away,  without  leaving 
any  other  impression  of  their  passage.  Those  who  undertook,  in  after- 
times,  to  collect  the  records  of  humanity,  in  place  of  transmitting  pure 
and  intact,  the  few  documents  of  which  they  yet  held  possession,  envel- 
oped them  with  fiction,  which  renders  the  truth  more  and  more  uncertain. 
But  it  must  be  said,  for  their  justification,  that  these  first  chroniclers 
had  especially  in  view,  the  inculcation  to  man  of  the  principles  of  socia- 
bility, morality,  and  I'eligion,  and  that  their  marvelous,  or  allegorical 
recitals  attained  much  more  directly  the  end  they  aimed  at,  than  if  they 
had  stated  the  naked  truth.  It  is  for  this  reason,  doubtless,  that  in- 
stead of  seeking,  laboriously,  the  primitive  source  of  the  arts  and  sciences, 
on  the  earth,  they  placed  it  in  the  heavens,  and  that  they  attributed  to 
their  gods,  or  to  men  they  deified,  all  great  discoveries.  On  this  account, 
therefore,  the  cradle  of  Medicine,  as  well  as  all  the  arts  of  first  necessity, 
is  surrounded  with  fables  and  allegories. 

I  shall  glide  slightly  over  this  medical  mythology,  which,  in  this  day, 
can  neither  delude  any  one,  nor  furnish  any  satisfactory  light  on  the 
state  of  the  science  in  primitive  times,  and  would  constitute  nothing 
more  than  a  display  of  erudition  as  sterile  as  it  would  be  out  of  place 
in  an  elementary  work.     I  shall  only  say  on  this  subject,  what  is  indis- 

"Lettres  de  Champollion  jeune,  relatives  au  Musee  Egyptien  de  Turin,  p.  25  et 
suivantes. 


28  PRiMrrivE  pekiod. 

pensable  to  be  known,  in  order  not  to  appear  ignorant  in  the  eyes  of 
men  who  have  a  smattering  of  the  history  of  our  Art. 

Thoth,  or  Theyt,  whom  the  Greeks  name  Hermes,  and  the  Latins  Mer- 
curius  (Mercury) ,  passed,  among  the  Egyptians,  as  the  inventor  of  all 
sciences  and  arts.  He  has  been  supposed  to  be  the  author  of  an  ency- 
clopedic collection,  in  which,  it  is  said,  was  comprised  all  the  wisdom  of 
the  ancient  priests  of  the  country.  But  this  collection  has  been  lost,  at 
an  unknown  period,  and  no  writer,  who  refers  to  it,  speaks  of  having  seen 
it :  all  refer  to  it  as  traditionary.  There  are  also  various  statements  as 
to  the  number  of  books  of  which  it  was  composed.  Some  say  there 
were  twenty  thousand ;  others  thirty-six  thousand ;  others,  on  the 
contrary,  reduce  the  number  to  forty-two  volumes,  only.  It  appears 
difficult,  if  not  impossible,  to  reconcile  these  opinions,  so  adverse  ;  never- 
theless some  have  attempted  so  to  do ;  among  others,  Galen,  Hornius. 
and  Bochard ;  but  none  of  their  explanations  are  reliable. 

Neither  is  there  a  better  agreement  as  to  the  person  of  Hermes,  nor 
of  the  time  in  which  he  lived.  According  to  many  conjectures,  which 
have  about  equal  claim  to  truth,  this  personage  was  Bacchus,  Zoroaster, 
Osiris,  Isis,  Scrapis,  Orus,  or  Apollo,  or  Shem  the  son  of  Noah.  Others 
think  that  Hermes  was  a  god,  to  whom  the  Egyptian  priests  dedicated 
all  their  scientific  productions,  by  inscribing  his  name  at  the  head  of 
their  writings.  Benjamin  Constant  emits  a  conjecture,  more  reasonable 
if  not  more  true.  "  In  the  great  religious  corporations,"  says  he,  "  the 
sacerdotal  instinct  warns  (I'avertissait)  them,  never  to  permit  any  indi- 
viduality to  be  manifested.  AVhat  we  have  taken  for  the  proper  names 
of  the  Chaldean  and  Phenician  writers,  was  probably  only  the  designation 
of  a  class.  The  word  sanchoniaton,  signifies,  among  the  Phenicians,  a 
savan,  a  philosopher,  or,  in  other  words,  a  priest.  Many  East-Indians 
have  assured  the  Chevalier  Jones,  that  Boudda  was  a  generic  name.  In 
Egypt,  all  the  works  on  religion  and  the  sciences  bore  the  name  of 
Thoth,  or  Hermes. "■■■' 

M.  Houdart,  who  agrees  with  this  last  view,  and  fortifies  it  by  proofs 
certainly  more  numerous  than  decisive,  gives,  beside,  on  the  contents  of 
this  hermetic  encyclopedia,  details  which  are  nowhere  else  found  as 
well  deduced.  I  think  I  cannot  do  better  than  give  a  textual  statement 
of  his  remarks.  "  Finally,"  says  Houdart,  "  that  the  reader  may  judge 
of  the  immensity  of  the  knowledge  of  the  savans  of  ancient  Egypt,  I 
place  before  him  the  titles  of  the  forty-two  volumes  of  this  hermetic  collec- 
tion.    The  first  two  contained  hymns  to  the  gods,  the  others,  duties  of 


'■'De  la  Religion.    Paris,  1824,  1. 11,  p.  120. 


MEDICINE   OF  THE   EGYPTIANS.  '29 

the  kings.  The  four  following  treated  of  the  order  of  the  wandering 
stars,  of  light,  and  of  the  rising  and  setting  of  the  sun  and  the  moon. 
In  ten  others  was  given  the  key  to  their  hieroglyphics ;  a  description  of 
the  Nile,  of  sacred  ornaments,  of  holy  places ;  and  beside  these,  instruc- 
tions in  astronomy,  in  cosmography,  and  the  geography  and  topography 
of  Egypt.  Ten  other  volumes  related  to  the  choice  of  victims,  divine 
worship,  religious  ceremonies,  festivals,  public  celebrations,  etc.  A  like 
number  of  volumes,  which  were  called  Sacred,  were  consecrated  to  the 
laws,  to  the  gods,  and  to  all  the  discipline  of  the  priesthood.  Finally, 
the  last  six  treated  of  Medicine.  We  leave  to  the  reader  the  cai-e  of 
deducing  all  the  results  of  such  an  encyclopedia.  What  we  wish  par- 
ticularly to  refer  to,  is,  that  the  last  six  volumes,  which  related  to  Medi- 
cine, embraced  a  body  of  doctrines,  complete  and  well  arranged.  The 
first  treated  of  anatomy,  the  second  of  diseases,  the  third  of  instruments, 
the  fourth  of  remedies,  the  fifth  of  diseases  of  the  eye,  and  the  last  of 
diseases  of  women.  It  must  be  agreed  that  this  distribution  was  very 
methodic.  In  the  first  place  there  was  given,  a  description  of  the 
human  body,  showing,  by  this,  that  it  was  necessary  to  commence  with 
a  knowledge  of  the  system  on  which  it  was  necessary  to  operate ;  then 
they  pass  to  the  study  of  diseases  ;  thence  to  medicines  and  instruments 
employed  in  their  treatment.  As  the  aifections  of  the  eye,  and  the 
diseases  of  women  are  very  frequent,  and  as  they  demand  particular 
attention,  they  were  studied  separately.  This  is  certainly  a  complete 
and  well  arranged  body  of  medical  matter.-'^ 

No  one  will  contest  the  excellency  of  this  plan  of  Medical  studies 
that  M.  Houdart  has  just  traced,  but  what  is  most  doubtful,  is,  that  a 
plan  so  well  arranged  can  be  referred  to  a  period  so  early  in  human  so- 
ciety. Without  attempting  to  discuss  this  point,  I  will  simply  remark, 
that  the  Hippocratic  collection  posterior  to  this,  by  a  thousand  years, 
according  to  the  supposed  date  of  the  encyclopedia,  does  not  present  as 
complete  and  as  methodic  a  system.  Further,  how  can  we  admit  that 
the  Egyptian  priests  would  attach  a  very  high  value  to  anatomical 
studies,  when  it  is  known  that  the  school  at  Cos,  initiated  in  the  doc- 
trines of  these  priests,  and  much  more  advanced  than  they,  in  all 
branches  of  medical  science,  possessed,  nevertheless,  but  very  vague 
notions  on  the  conformation  of  the  human  body,  except  in  what  relates 
to  osteology.  Everything  justifies  us  in  believing  that  the  plan  of  med- 
ical education  which  is  attributed  to  the  priests  of  Egypt,  is  the  work 
of  some  writer  of  the  Alexandrian  school ;  for  it  was  about  the  epoch 

^'"Etudes  Historiques  et  Antique  sur  la  Vie  et  la  Doctrine  d'Hippocrate,  et 
sur  1'  etat  de  la  Medecine  avant  lui,"  par  M.  Houdart.    Paris,  18i0,  p.  135. 


30  PRIMITIVE   PERIOD. 

of  the  foundation  of  that  city,  that  anatomical  researches  and  medical 
philosophy  began  to  flourish. 

Nevertheless,  the  description  that  M.  Houdart  gives  of  the  progress- 
ive march  of  the  sciences  in  Egypt,  and  in  particular  of  the  method 
followed  by  the  priests  in  the  practice  of  medicine,  is  both  interesting 
and  instructive.  On  this  account,  I  continue  to  quote  his  remarks,  but, 
at  the  same  time,  expressing  my  doubts  of  the  exaggerated  appreciation 
of  the  results  which  this  writer  conceives  are  derived  from  the  Egyp- 
tian school.  "  It  is  not  necessary  to  suppose,"  he  adds,  "  that  Medicine 
reached,  suddenly,  in  Egypt,  this  degree  of  perfection.  As  was  common 
among  other  people  of  high  antiquity,  they  commenced,  in  the  first 
place,  as  we  learn  from  Strabo,  by  exposing  the  sick  in  public,  so  that 
any  of  those  who  passed  by,  that  had  been  similarly  attacked  and  cured, 
might  give  their  advice  for  the  benefit  of  the  sufferers."  At  a  later 
period,  this  plan  was  much  better  calculated  to  accelerate  the  progress 
of  the  art ;  for  all  who  were  cured  of  disease  were  required  to  go  and 
make  an  inscription  in  the  temples,  of  the  symptoms  of  their  disease, 
and  the  curative  agents  which  had  been  beneficial  to  them.  The  temples 
of  Canopus  and  Vulcan,  at  Memphis,  became  the  principal  depots  of 
these  registers,  and  they  were  kept  with  the  same  care  as  the  archives 
of  the  nation.  Eor  a  long  time,  every  one  had  the  privilege  of  going 
to  consult  them,  and  of  choosing  for  his  sickness,  or  that  of  his  neigh- 
bors, the  medicaments  of  which  experience  had  confirmed  the  value. 
This  method  was  very  good,  notwithstanding  its  inconveniences,  to 
advance  science,  because  it  rested  entirely  upon  observation.  In  this 
way,  must  have  been  collected  a  prodigious  quantity  of  facts,  from 
which  might  be  deduced  correct  principles  in  the  practice  of  Medicine, 
and  this,  indeed,  was  brought  about.  The  priests,  who  were  charged 
with  the  study  of  these  observations,  did  not  hesitate  to  seize  upon  the 
exclusive  practice  of  the  Art,  and  when  they  had  collected  a  great  mass 
of  facts,  they  formed  a  Medical  Code,  the  fruit  of  the  experience  of  ages, 
which  is  called  by  Diodorus,  of  Sicily,  the  Sacred  Book,  from  the  direc- 
tions of  which  they  were  never  permitted  to  vary.  It  was,  doubtless, 
this  code,  which  was  afterward  attributed  to  Hermes,  that  made  up  the 
collection  spoken  of  by  Clement,  of  Alexandria,  and  which  the  Pasto- 
phores  followed  in  the  practice  of  Medicine  If,  in  following  the  rules 
there  laid  down,  they  could  not  save  their  patients,  they  were  not 
held  responsible ;  but,  according  to  Diodorus,  of  Sicily,  they  were  pun- 
ished with  death  if,  after  departing  from  them  the  result  did  not  justify 


~  According  to  Herodotus  and  Strabo,  the  same  usage  appears  to  have  existed 
among  the  Babylonians  and  Lusitanians. 


MEDICINE   OF  THE   EGYPTIANS.  31 

their  course.  Unquestionably  this  was  an  atrocious  law,  and  must 
have  arrested  all  ulterior  progress  in  the  Healing  Art.  Xevertheless, 
it  should  be  stated,  that  it  was  not  made  before  the  correctness  of  those 
principles  had  been  well  established.  Diodorus  is  decisive  on  this  sub- 
ject ;  he  says,  positively,  that  the  design  of  a  law,  so  severe,  was,  that 
a  practice  confirmed  by  long  experience,  and  supported  by  the  authority 
of  the  greatest  masters  of  the  Art,  was  preferable  to  the  limited  expe- 
rience of  each  particular  physician." 

I  have  already  indicated  my  objections  to  M.  Houdart,  for  exaggera- 
ting so  much  the  progress  of  Egyptian  Medicine  in  these  remote  times, 
and  I  shall  not  add  to  what  I  have  said,  but  one  simple  cjuestion.  I 
will  ask  of  this  erudite,  who  attempts  to  justify,  like  Diodorus,  this 
foolish  and  iniquitous  Egyptian  law,  what  judgment  he  would  give,  to- 
day, upon  the  Sovereign  or  Senate  who  would  attempt  to  re-establish 
and  execute  a  similar  one,  under  the  pretext  that  our  medical  code  is 
the  fruit  of  the  experience  of  ages,  and  that  the  solidity  of  the  princi-" 
pies  which  serve  as  its  base,  is  sufficiently  established  ?  Doubtless,  he 
could  not  sufficiently  curse  such  a  senseless  tyranny,  so  contrary  to  the 
progress  of  science  and  the  best  interests  of  the  diseased.  Finally,  I 
will  ask,  how  is  it  that  he  has  conceived  so  high  an  idea  of  the 
Egyptian  doctrine,  which  rests  upon  some  vague  and  doubtful  traditions, 
while  he  blames,  with  excessive  severity,  the  Hippocratic  doctrine,  of 
which  there  remains  to  us  irrefutable  monuments  which  have  excited  the 
admiration  of  the  greatest  masters  ? 

It  ia  usually  supposed  that  the  practice  of  embalming,  which  goes 
back  to  an  immemorial  period,  as  already  indicated,  was  well  calculated 
to  familiarize  the  Egyptian  priests  of  that  early  day  with  anatomical 
researches.  But  Sprengel  has  justly  observed,  that  this  process  was 
too  rude  to  have  contributed  very  much  to  the  advancement  of  the  sci- 
ence. He  adds,  that  according  to  Herodotus,  the  people  had  a  horror 
of  these  proceedings,  and  that  they  pursued  and  threw  stones  at  the 
parachute  who  made  the  incision,  through  which  were  introduced  into 
the  corpse  the  ingredients  destined  to  dry  and  preserve  it.  This  sub- 
altern operator  was  obliged  to  fly  immediately  after  he  had  done  his 
work,  in  order  not  to  become  the  victim  of  the  animadversion  of  his 
assistants.  When  Pliny  assures  us  that  the  kings  of  Egypt  permitted 
the  opening  of  the  corpse,  for  the  purpose  of  discovering  the  causes  of 
diseases,  he  always  means  the  Ptolemies,  under  whose  reign  anatomy 
was  carried  to  a  very  high  degree  of  perfection,  f 

'"Etudes  Historiques  et  Critiques,"  etc.,  j.  136. 

f  C.  Sprengel,  "  Histoire  de  la  Me'dicine,  traduction  de  M.  Jourdan,"  t.  I,  p.  60 
et  suiv.     See  "  I'Histoire  de  TAnatomie,"  par  Th.  Lauth.  Strasbourg,  1815,  liv.  1, 


32  PRIMITIVE    PERIOD. 

According  to  the  authors  I  have  just  named,  there  were  three  sorts  of 
embalmments,  namely :  that  of  the  first  class,  reserved  for  men  of  qual- 
ity and  wealth,  which  cost  one  talent ;  that  of  the  second  class,  which 
was  adopted  by  families  of  moderate  means,  which  cost  about  twenty 
mines ;  lastly,  a  mode  of  embalmment  for  the  poor,  which  consisted 
simply  in  washing  the  body  and  macerating  it  for  seventy  days  in  lye. 
In  the  process  of  embalming  the  first  and  middle  classes,  the  brain 
was  removed  by  an  opening  through  the  nasal  fossae,  and  an  incision 
was  made  on  the  left  side  of  the  abdomen,  through  which  the  intes- 
tines were  withdrawn,  and  spices  and  more  or  less  costly  aromatics 
were  introduced ;  after  which,  the  body  was  washed,  as  above  stated, 
then  spread  over  with  gum,  and  wrapped  in  bandages  of  linen." 

The  Egyptian  nation  was  divided,  from  the  earliest  times,  into  six  orders, 
as  follows :  the  king  and  princes,  priests,  soldiers,  shepherds,  laborers, 
and  lastly,  artisans.  The  order  of  the  priesthood  was  most  respected 
and  the  most  powerful ;  it  was  the  depot  of  the  laws,  science,  and  reli- 
gion. The  sovereign,  before  taking  the  reins  of  government  in  his 
hands,  was  affiliated  to  the  sacerdotal  order,  and  initiated  into  its  mys- 
teries. The  care  of  the  priests  to  conceal  their  doctrines  is  well  known, 
and  that  they  might  do  it  more  efiectually,  and  transmit  them  to  their 
successors,  they  employed  a  peculiar  language  and  mode  of  writing, 
termed  hieroglyphical  or  sacred,  which  differed  essentially  from  the 
common  language  of  the  people.  While  the  vulgar  prostrated  them- 
selves before  rude  images,  emblems  of  the  attributes  of  the  divinity, 
or  of  the  wonders  of  creation,  the  learned  classes,  which  included  med- 
ical men,  recognized  an  invisible  and  eternal  Sprit,  the  Supreme  Gov- 
ei'nor  of  the  universe. 

11.    MEDICINE    OF    THE    HEBREWS. 

The  Sacred  History  says,  positively,  that  Moses,  having  been  rescued 
from  the  river  by  one  of  the  daughters  of  Pharaoh,  was  reared  in  the 
court  of  that  Prince,  and  instructed  in  all  the  knowledge  of  the  Egyp- 
tian priesthood,  in  which  he  became  a  proficient.  On  this  account, 
when  he  presented  himself  before  his  sovereign,  to  demand,  in  the  name 
of  the  God  of  Israel,  the  freedom  of  his  brethren,  who  were  reduced  to 
an  unjust  and  cruel  servitude,  he  was  not  at  all  embarrassed  by  the 


where  the  question,  if  the  Egyptians  possessed  an  anatomical  knowledge,  is  exam- 
ined and  thoroughly  answered  negatively. 

"'C.  Sprengel,  i6i£f«OT. — Herodotus  liv.  II,  chap.  LXXXV-LXXXVI.  Diodorus, 
chap.  XCI.  Pariset,  "  Memoire  sur  les  Causes  de  la  Peste."  Paris,  1837,  page 
4,  et  suiv. 


MEDICINE   OF  THE   HEBREWS.  33 

prestiges  of  the  magicians  and  savans  that  Pharaoh  so  frequently  sum- 
moned to  meet  him  in  the  palace.  He  proved  the  legitimacy  of  his 
mission,  in  confounding  the  pride  of  the  magicians  by  prodigies  more 
wonderful  than  theirs,  and  finally  overcame  the  interested  obstinacy  of 
the  king,  and  had  the  glory  of  delivering  his  brethren  from  the  yoke 
that  had  pressed  so  heavily  upon  them  for  nearly  two  hundred  years. 
All  are  familiar  with  the  great  obstacles  he  overcame  in  leading  them 
back  to  the  land  of  their  forefathers,  and  how  well  he  availed  himself 
of  long  and  weary  wanderings  in  the  wilderness,  to  give  to  them  the 
moral  and  political  laws  inspired  by  God. 

The  writings  of  Moses  constitute  a  precious  monument  for  the  history 
of  Medicine  ;  for  they  embrace  hygienic  rules  of  highest  sagacity,  and 
which  may  be  regarded  as  a  detached  fragment  of  Egyptian  science. 
It  is  in  Leviticus  that  the  prophet-legislator  has  recapitulated  the 
greater  part  of  the  rules  concerning  the  care  to  be  given  to  the  health. 
The  eleventh  chapter  contains  a  long  enumeration  of  animals  reported 
impure,  that  is,  unhealthy  ;  among  which  are  mentioned  the  rabbit  and 
the  hog,  whose  flesh  produces  no  injurious  effects  in  European  climates, 
but  might  have  done  in  Egypt  and  India,  among  men  whose  habits  dif- 
fered so  much  from  ours.  It  may  be,  moreover,  that  the  species  desig- 
nated by  these  names  were  not  the  same  as  those  with  which  we  are  so 
familiar.  In  short,  it  is  possible  that  Moses,  in  making  these  prohibi- 
tions, had  other  views  than  those  ascribed  to  him. 

The  twelfth  and  fifteenth  chapters  of  the  same  book  were  designed 
to  regulate  the  relation  of  a  man  to  his  wife.  In  reading  these  pre- 
cepts, one  can  not  repress  a  sentiment  of  admiration  for  the  wis- 
dom and  foresight  which  made  such  salutary  regulations  a  religious 
duty.  The  following  extract  will  enable  the  reader  himself  to  judge 
of  this. 

1.  "  The  Lord  spake  again  to  Moses,  and  said  to  him, 

2.  "  Speak  to  the  children,  saying,  if  a  woman  have  conceived  seed, 
and  borne  a  man  child,  then  shall  she  be  unclean  seven  days ;  according 
to  the  days  of  the  separation  of  her  infirmity  shall  she  be  unclean. 

3.  "  And  in  the  eighth  day,  the  flesh  of  his  foreskin  shall  be  circum- 
cised. 

4.  "And  she  shall  then  continue  in  the  blood  of  her  purifying  three 
and  thirty  days ;  she  shall  touch  no  hallowed  thing,  nor  come  into  the 
sanctuary,  until  the  days  of  her  purifying  be  fulfilled. 

5.  "But  if  she  bear  a  maid  child,  she  shall  be  unclean  two  weeks,  as 
in  her  separation,  and  she  shall  continue  in  the  blood  of  her  purifying 
threescore  and  six  days. 


34  PRIMITIVE   PERIOD. 

6.  "And  when  the  days  of  her  purifying  arc  fulfilled,  for  a  son  or  for 
a  daughter,  she  shall  bring  a  lamb  of  the  first  year  for  a  burnt-off'ering, 
and  a  young  pigeon  or  a  turtle-dove  for  a  sin  ofiering,  unto  the  door  of 
the  tabernacle  of  the  congregation,  unto  the  priest,  *  *  '•■•=  and  the 
priest  shall  make  an  atonement  for  her,  and  she  shall  be  clean." 

Chap.  XV,  V.  19,  "And  if  a  woman  have  an  issue,  etc.,  she  shall  be  put 
apart  seven  days. 

20.  "Whatever  shall  touch  her  shall  be  impure  till  even." 

24.  "And  if  any  man  lie  with  her  at  all,  and  her  flowers  be  upon  him, 
he  shall  be  unclean  seven  days,  and  all  the  bed  whereon  he  lieth  shall 
be  unclean. 

25.  "And  if  a  woman  have  an  issue  of  her  blood,  many  days  out  of 
the  time  of  her  separation ;  all  the  days  of  the  issue  of  her  uucleanliness 
shall  be  as  the  days  of  her  separation:  she  shall  be  unclean." 

28.  "But  if  she  be  cleansed  of  her  issue,  then  shall  she  number  to 
herself  seven  days ;  and  after  that  she  shall  be  clean. 

29.  "And  on  the  eighth  day  she  shall  take  unto  her  two  turtles,  or 
two  young  pigeons,  and  bring  them  unto  the  priest,  to  the  door  of  the 
tabernacle  of  the  congregation." 

Apart  from  the  religious  ceremonies,  the  utility  of  which  is  incon- 
testable, in  order  to  secure  the  execution  of  the  hygienic  precepts — might 
it  not  be  said  that  these  are  extracts  from  a  modern  work  on  hygienics  ? 
What  could  be  more  salutary  than  the  momentary  separation  of  married 
persons  at  the  periodical  return  of  certain  functions  which  almost  amount 
to  an  infirmity  with  women  ?  or  what  could  be  more  ingeniously  con- 
trived to  prevent  the  disgust  that  might  arise  from  an  uninterrupted 
cohabitation?  The  author  of  Emilius  gives  similar  counsel,  three 
thousand  years  later. 

The  Bible  also  prescribes  frequent  ablutions,  a  custom  which  has  al- 
ways appeared  to  be  necessary  in  hot,  dry  countries,  and  among  a  people 
who  made  no  use  of  body-linen.  But  what  more  excites  the  astonish- 
ment of  physicians,  is  the  tableaux  that  Moses  has  made  of  the  white 
leprosy,  and  the  regulations  he  established  to  prevent  its  propagation. 
He  has  given  the  following  characteristics  of  this  disease,  in  the  thir- 
teenth chapter  of  Leviticus. 

2.  "  When  a  man  shall  have  in  the  skin  of  his  flesh  a  swelling,  as  a 
scab  or  bright  spot,  and  it  be  in  the  skin  of  his  flesh,  like  the  plague  of 
leprosy,  then  he  shall  be  brought  unto  Aaron,  the  priest,  or  unto  one  of 
his  sons,  the  priests. 

3.  "And  the  priest  shall  look  on  the  plague  in  the  skin  of  the  flesh, 
and  when  the  hair  in  the  plague  is  turned  white,  and  the  plague  in 


MEDICINE  OF  THE   HEBREWS.  35 

sight  "be  deeper  than  the  skin  of  his  flesh,  it  is  a  plague  of  Leprosy ;  and 
the  priest  shall  look  at  him  and  pronounce  him  unclean,"  etc. 

Ancient  authors  have  confounded  under  the  name  of  Leprosy,  a  great 
number  of  diverse  affections ;  hence  it  results,  that  these  descriptions  do 
not  agree  with  each  other,  nor  with  the  writings  of  Moses.  Cutaneous 
pathology  was  a  real  chaos,  which  has  only  been  reduced  to  a  system 
very  recently,  so  that  it  is  impossible  now  to  give  an  opinion  on  the 
exactness  of  the  signs  above  indicated.  Some  of  them  conform  to  a  dis- 
ease called  White  Leprosy,  by  modern  dermatologists,  but  others  do  not. 
What  augments  our  uncertainty,  is  the  opinion  universally  admitted, 
and  very  probable  too,  that  by  the  influence  of  hygienic  conditions,  en- 
tirely different,  certain  diseases  may  have  disappeared,  or  become  so 
modified,  as  to  be  of  no  importance,  while  new  ones  may  have  been 
developed.  Without  this  consideration  we  would  be  led  to  suppose,  that 
it  was  a  mere  prejudice,  very  excusable  at  so  early  a  period  in  medical 
science,  that  caused  Moses  to  write  concerning  the  leprosy  which  clung 
to  the  clothing,  and  to  the  walls  of  houses,  and  which,  according  to  the 
sacred  writer,  manifested  its  presence  on  inanimate  objects  by  evident 
characteristics." 

After  the  promulgation  of  the  Decalogue,  the  man  most  prized  in  the 
Holy  Scriptures  for  his  science,  was  Solomon.  They  tell  us  that  this 
monarch  surpassed  in  wisdom  all  the  Orientals,  and  even  the  Egyptians, 
that  "  he  spoke  five  hundred  proverbs,  and  his  songs  were  three  thou- 
sand. He  spoke  of  plants,  from  the  cedar  of  Lebanon,  even  unto  the 
hyssop  that  springeth  out  of  the  wall;  he  spoke  also  of  beasts  and 
of  fowl,  and  of  creeping  things,  and  of  fishes."  The  historian  Josephus 
adds,  "that  God  gave  to  this  prince  a  perfect  knowledge  of  the  proper- 
ties of  all  the  productions  of  nature,  and  that  he  availed  himself  of  it, 
to  compound  remedies,  extremely  useful,  some  of  which  had  even  the 
virtue  to  cast  out  devils,  "f 

It  is  clear  from  the  above,  that  Moses  always  gave  his  instructions 
concerning  leprosy  and  other  infirmities,  to  the  priests  only;  from 
which  it  may  be  inferred  that  at  this  epoch,  the  Levites  joined  the 
practice  of  Medicine,  to  their  sacerdotal  functions.  It  appears  that 
they  maintained  for  a  long  time,  this  double  relationship  to  society,  for 
there  is  no  mention  made  of  lay  physicians  among  the  Jews,  except  in 
the  Book  of  Ecclesiastes,  the  author  of  which  lived  in  the  third  century 
before  Jesus  Christ.     The  following  references  are  made  on  this  subject: 

"  Lev.  Chap.  XHI,  et  XIV. 

t  Liv.  Vin.  Chap.  n. — Leclerc,  "  Hist,  de  la  Medecine."     Ire  partie,  Liv. 
Chap.  HI. 


36  PRIMITIVE   PERIOD. 

"  Honor  the  physician,  because  he  is  indispensable,  for  the  Most  High 
has  created  him." 

"For  all  Medicine  is  a  gift  from  God,  and  the  physician  shall  re- 
ceive homage  from  the  King." 

"The  Science  of  Medicine  shall  elevate  the  physician  to  honor,  and 
he  shall  be  praised  before  the  great." 

"The  Most  High  has  created  the  Medicines  out  of  the  earth,  and  he 
that  is  wise  will  not  abhor  them."" 

III.    MEDICINE    OF    THE    ORIENTAL    INDIANS. 

Under  the  name  of  Indians,  we  comprise  all  those  tribes  that  inhabit 
that  vast  extent  of  country,  bounded  on  the  east  by  China,  on  the  west 
by  Persia,  on  the  north  by  little  Thibet,  and  on  the  south  by  the  sea. 
Though  now  divided  into  many  kingdoms  or  principalities,  the  inhabit- 
ants of  these  countries  appear  to  have  had  in  antiquity,  a  common 
origin,  the  same  religion,  and  similar  institutions.  The  mildness  of 
the  climate,  and  the  fertility  of  the  soil,  which  produced  abundantly 
the  necessities  of  life,  must  have  invited  early  the  occupation  of 
man ;  and  authentic  monuments  attest  that  India  possessed  the  bless- 
ings of  civilization,  while  Europe  was  still  plunged  in  the  darkness  of 
barbarism.  Some  writers  even  go  so  far,  as  to  pretend  that  the  torch  of 
civilization,  was  transported  from  the  banks  of  the  Ganges,  to  the  banks 
of  the  Nile ;  but  this  is  only  a  simple  conjecture,  devoid  of  proof,  while 
the  contrary  view  is  at  least  as  probable. 

The  Indians  are  divided  into  many  castes,  of  which  the  most  noble 
is  that  of  the  priests  or  bramins.  These  only  have  the  privilege  to  ex- 
ercise the  functions  of  priests  and  physicians ;  they  alone  learn  the 
Sanscrit,  which  is  the  language  of  the  learned  of  those  countries,  and 
in  which  all  their  books  are  written.  Their  medical  knowledge  is  col- 
lected in  a  book  which  they  name  Vagadasastir.  We  possess  of  this 
work  only  a  few  extracts,  the  exactness  of  which  I  dare  not  guarantee; 
for  such  as  they  are,  they  give  too  poor  an  opinion  of  the  knowledge 
and  judgment  of  the  Hindoo  doctors. 

This  organon  of  Medicine,  is  divided  into  eight  parts  ;  the  first  treats 
of  diseases  of  children  ;  the  second  of  bites  of  venomous  animals ;  the 
third  of  affections  of  the  mind,  which  are  produced,  as  generally  sup- 
posed,  by  demons;  the  fourth  part,  is  consecrated  to  diseases  of  the 
sexual  organs ;  the  fifth  to  hygiene  and  prophylactics ;  the  sixth  to 
surgery ;  the  seventh  to  treatment  of  diseases  of  the  eye,  and  of  the  head ; 

"  Ecclesiastes,  Chap.  XXXVIII,  verses  1,  2,  3,  4. 


MEDICINE   OF  THE   ORIENTAL   INDIANS.  37 

the  eighth  gives  directions  for  the  preservation  of  youth,  and  the  beauty 
of  the  hair.  It  is  plain  that  no  philosophic  idea,  lies  at  the  foundation 
of  the  arrangement  of  this  medical  encyclopedia. 

They  admit  three  principal  sources  of  internal  diseases,  viz :  flatulency, 
wodum,  vertigo,  bittum,  impure  humors,  {chestum.  They  further  believe 
that  all  cutaneous  diseases,  were  caused  by  worms.  According  to  them 
there  were  in  the  human  body,  one  hundred  thousand  parts,  of  which  seven- 
teen thousand  were  vessels.  Each  one  of  these  is  composed  of  seven  tubes, 
giving  passage  to  ten  species  of  gases,  which,  by  their  conflicts,  engend- 
ered a  crowd  of  diseases.  They  placed  the  origin  of  the  pulse,  in  a 
reservoir,  situated  beneath  the  umbilicus.  This  reservoir  was  four 
fingers  wide,  by  two  long,  and  divided  into  seventy  two  thousand 
canals,  which  were  distributed  to  all  parts  of  the  body.  Upon  a  physi- 
cian examining  the  pulse  of  a  patient,  he  observed  at  the  same  time 
very  carefully,  his  countenance,  believing  that  every  change  in  the  pul- 
sation of  the  artery,  answered  to  a  corresponding  change  in  the  expres- 
sion of  his  face.  He  examined  also  the  feces  and  the  urine,  consulted 
the  stars,  the  flight  of  birds,  the  accidental  incidents  in  his  visit,  he 
drew,  in  a  word,  his  prognosis  from  a  thousand  different  circumstances. 
but  omitted  those  which  alone  could  be  available  to  him,  namely,  the 
symptoms  indicating  the  state  of  the  organs. 

The  following  maneuver,  admirably  illustrates  the  silly  credulity  or 
arrant  charlatanism  of  the  Hindoo  physicians.  He  let  fall  from  the 
end  of  a  straw,  a  drop  of  oil,  in  the  vessel  containing  a  specimen  of  his 
patient's  urine.  If  the  oil  was  precipitated,  and  attached  itself  to  the 
bottom  of  the  vessel,  he  predicted  an  unfavorable  result;  if,  on  the  con- 
trary, the  oil  floated,  he  announced  a  favorable  termination ;  from  which, 
according  to  this  method,  an  unfavorable  prognosis  must  have  been 
rarely  made. 

With  ideas  so  ridiculous,  on  the  origin  and  diagnosis  of  diseases,  it 
would  seem  to  follow,  that  their  therapeutics  must  have  been  miserable 
indeed.  Nevertheless,  we  are  assured  that  they  were  very  successful  in 
the  choice  of  remedies,  the  proper  time  for  their  use,  and  in  the  manner 
of  preparing  and  presenting  them.  They  are  said  to  have  had  an  oint- 
ment, that  caused  the  cicatrices  of  variola  to  disappear.  They  cured 
the  bites  of  venomous  serpents,  with  a  remedy,  whose  composition  is  un- 
known to  Europeans.  In  health,  as  in  disease,  their  attention  was  es- 
pecially directed  to  the  regimen.  They  observed  in  their  persons,  and 
in  everything  about  them,  a  minute  and  even  excessive  cleanliness.  In 
short,  we  find  in  this  country  still,  as  in  ancient  Egypt,  several  classes 
of  physicians,  each  of  which  treats  certain  kinds  of  diseases  only.  They 
pretend  that  their  science  is  derived  directly  from  heaven ;  and  it  is 


3S  PRIMITIVE   PERIOD. 

owing  to  this  belief,  doubtless,  that  they  have  not  made  any  improve- 
ments on  it,  for  thousands  of  years. 

IV.     MEDICINE   OF    THE    CHINESE. 

The  Chinese  offer  to  our  observation  the  unique  spectacle,  in  the 
records  of  the  human  race,  of  a  people  who  have  preserved,  for  more 
than  four  thousand  years,  their  manners,  laws,  religion,  literature,  lan- 
guage, name,  and  territory.  This  remarkable  phenomenon  is  certainly 
related  to  a  concourse  of  extraordinary  circumstances,  well  worthy  the 
attention  of  the  philosopher  and  statesman ;  but  we  can  not  dwell  on 
this  subject  especially,  as  we  do  not  possess  the  documents  necessary 
thereto. 

We  simply  remark,  that  in  all  time,  the  sovereigns  of  China  have 
taken  extraordinary  care  to  prevent  all  contact  or  exchange  of  ideas 
between  their  subjects  and  foreigners.*  Police  regulations,  customs,  su- 
perstitions, and  national  prejudice,  have  all  united  to  isolate  the  Chinese 
from  the  rest  of  the  world.  The  language  and  writing  of  the  manda- 
rins and  savans  are  so  difficult,  that  it  requires  nearly  an  entire  life 
to  learn  them.  It  is  only  by  force  of  perseverance  in  surmounting  a 
thousand  obstacles,  and  braving  a  thousand  dangers,  that  the  intrepid 
missionaries  have  been  enabled  to  lift  a  corner  of  the  vail  with  which 
the  science  and  history  of  this  country  are  enveloped.  We  owe  to 
their  apostolic  zeal,  the  little  we  have  to  say  on  these  subjects.f 

The  antiquity  of  the  Chinese,  as  that  of  every  nation,  is  mingled 
with  traditions  more  or  less  uncertain  and  fabulous.  But  from  the 
year  2357,  before  Jesus  Christ,  their  chronology,  says  Father  Du  Halde, 
is  perfectly  well  arranged ;  their  tables  exhibiting  the  names  of  their 
emperors,  the  duration  and  principal  events  of  their  reigns,  the  revolu- 
tions, and  interregnums ;  and  the  whole  is  narrated  in  a  simple  manner, 
without  any  admixture  of  supernatural  statements.  This  chronology 
is  supported,  beside,  by  the  observations  of  eclipses,  whose  dates  coin- 
cide exactly  with  the  calculations  of  the  most  eminent  astronomers  of 
Europe.     In  fine,  Confucius,  the  greatest  Chinese  philosopher,  a  sage 

''  But  a  new  era  commences ;  the  barriers  which  have  excluded  all  strangers 
from  entering  this  empire,  have  just  been  broken  down  by  British  cannon.  The 
day  is  not  far  distant  when  the  learned  curiosity  of  Europeans  may  be  gratified 
by  the  study  of  Chinese  monuments. 

•j-The  description  and  history  of  China,  by  Father  Du  Halde;  the  fragments 
of  Chinese  medicine,  translated  into  Latin,  by  Father  Michael  Boym,  and  pub- 
lished by  Cleyer,  have  furnished  the  materials  of  nearly  all  that  has  been  writ- 
ten up  to  this  time  on  that  country. 


MEDICINE   OF  THE   CHINESE.  39 

whose  opinion  is  of  great  weight,  on  account  of  his  worth  and  probity, 
has  never  questioned  its  correctness. 

They  attribute  the  invention  of  Medicine  to  one  of  their  emperors, 
named  Hoam-ti,  who  was  the  third  of  the  first  dynasty.  He  is  said  to 
have  reigned  2687  years  before  the  Christian  era,  which  goes  back 
many  ages  before  the  universal  deluge,  to  an  epoch  of  which  their  his- 
tory does  not  treat  in  the  same  authentic  manner  as  is  referred  to  above. 
He  is  regarded  as  the  author  of  a  work  entitled  NuyKini,  which  still 
serves  as  a  guide  for  medical  practice.  In  this  work  is  found  a  theory 
of  the  pulse,  extremely  minute,  which  clearly  reminds  us  of  the  sphyg- 
mics  of  the  successors  of  Erasistratus.  For  this  reason,  it  has  been 
supposed,  and  not  without  probability,  that  the  disciples  of  this  physi- 
cian, who  were  established  in  Bactriana,  after  the  invasion  of  Alexan- 
der the  Great,  communicated  to  the  Chinese  doctors  their  ideas  on  this 
subject.  The  chronicles  of  the  mandarins  confirm  this  conjecture,  for 
they  state  that  at  that  epoch  the  savans  of  Samarcand  fixed  their  resi- 
dence among  them.  It  is,  then,  very  reasonable  that  Nuy'Kim'  is  an 
Apocryphal  book,  or  rather  a  collection  of  fragments  belonging  to  vari- 
ous authors  of  different  eras.  This  is  made  probable  by  the  following 
resume  extracted  from  the  articles  edited  by  Cleyer.^--' 

There  are  set  forth  in  it  two  radical  hidden  principles,  heat  and 
moisture,  which  give  life  and  movement  to  all  things.  The  spirits  are 
the  vehicles  of  heat,  just  as  the  blood  is  the  vehicle  of  moisture.  The 
harmony  or  disunion  of  these  two  principles,  their  excess  or  their 
deficiency,  in  a  word,  their  combinations  and  their  various  proportions, 
produce  that  infinite  variety  of  phenomena  that  are  seen  in  the  world- 
They  produce,  also,  the  good  and  the  bad  constitution,  health  and 
disease,  life  and  death. 

An  immoderate  degree  of  heat  causes  cold,  and  vice  versa,  just  as 
autumn  succeeds  summer,  and  spring  succeeds  winter. 

Heat  naturally  ascends  and  occupies  the  highest  places.  It  is  in 
perpetual  agitation  by  diffusion,  expansion,  rarefaction,  and  penetra- 
tion. Moisture,  on  the  contrary,  tends  downward,  and  seeks  repose ;  it 
becomes  condensed  and  viscid,  and  stops  the  pores. 

As  in  the  universe,  we  see  three  chief  objects,  the  heavens  above,  the 
earth  beneath,  and  man,  who,  placed  between  these  two,  participates  in 
the  celestial  as  well  as  terrestrial  nature ;  so  we  distinguish  in  the 
human  body,  three  principal  regions,  namely:  the  superior,  extending 


-  Cleyer,  "  Specimen  Medicse  Sinite."    Francofurti,  anno  1682.    See,  especially, 
the  fragment  No.  2,  entitled,  "  Tractatus  de  Pulsibus." 


40  PRIMITIVE   PERIOD. 

from  the  head  to  the  epigastrium,  which  contains  the  heart,  the 
pericai'dium  and  the  lungs,  which  are  all  above  the  diaphragm  ;  the  mid- 
dle, which  is  bounded  below  by  the  umbilicus,  and  incloses  the  stomach 
with  its  annexes,  the  spleen,  the  liver  and  its  gall-bladder,  and  the  dia- 
phragm ;  lastly,  the  inferior,  which  comprehends  the  kidneys  the  blad- 
der, the  intestines,  and  the  abdominal  members. 

To  each  of  these  three  described  regions,  correspond  three  kinds 
of  pulse  on  the  hand.  The  supreme  or  celestial  pulse,  which  is 
placed  at  the  articulation  of  the  forearm  with,  the  wrist.  It  is  undu- 
lating, full,  and  prominent,  and  is  governed  by  heat.  That  on  the  right 
arm  shows  the  state  of  the  heart  and  pericardium  ;  that  on  the  left 
side,  the  state  of  the  lungs  and  mediastinum.  The  inferior,  or  terres- 
trial pulse,  situated  lower  down,  at  the  articulation  of  the  wrist  with 
the  hand,  is  influenced  particularly  by  moisture ;  on  this  account  it  is 
deep-seated.  That  on  the  right  side  indicates  the  state  of  the  ureters, 
the  corresponding  kidney  and  small  intestine ;  that  on  the  left  side 
shows  the  condition  of  its  corresponding  kidney  and  the  large  intestine. 
Finally,  the  middle  pulse,  or  that  of  man,  properly  speaking,  is  between 
the  other  two,  on  the  middle  of  the  carpus.  It  is  produced  by  a  ming- 
ling of  heat  and  moisture,  neither  too  high  nor  too  low,  but  properly 
combined.  On  the  right  hand,  it  marks  the  state  of  the  stomach  and 
spleen  ;  on  the  left,  that  of  the  liver  and  diaphragm. 

These  three  kinds  of  pulse  are  sometimes  compared  to  a  tree,  of  which 
the  superior  pulse  constitutes  the  superior  branches  and  leaves ;  the 
middle  pulse,  the  trunk ;  and  the  inferior,  the  roots. 

The  examination  of  the  pulse,  not  only  enables  the  Chinese  physi- 
cians to  show  the  seat  of  the  disease,  but  also  to  judge  of  its  duration 
and  gravity.  They  pi-oceed  to  this  examination  after  a  method  which 
appertains  to  them  alone.  They  place  the  arm  of  the  patient  on  a 
cushion,  then  they  apply  the  index,  the  middle  and  ring-fingers  on  the 
anterior  face  of  his  wrist,  in  such  a  way  that  the  index-finger  may  be 
nearest  the  arm,  and  the  ring  finger  nearest  the  hand.  They  elevate 
and  depress  each  finger,  alternately,  with  more  or  less  force,  like  one 
playing  on  an  organ.  At  the  same  time,  they  observe  closely  the  move- 
ments of  respiration,  being  persuaded  that  there  exists  between  them 
and  the  arterial  pulse  an  intimate  connection.  They  examine,  also, 
during  a  limited  number  of  respirations,  each  of  the  nine  pulses,  which 
are  formed,  according  to  their  doctrine,  on  each  hand,  and  they  deduce 
from  these  their  diagnosis  and  prognosis,  which  they  immediately  an- 
nounce without  any  uncertainty  or  hesitation.  They  make  their  pre- 
scriptions on  the  spot,  and  usually  administer  their  remedies,  receive 
their  fees,  and  retire,  not  to  return  unless  they  shall  be  recalled. 


MEDICINE   OF   THE   CHINESE.  41 

Independently  of  the  two  active  principles  of  which  we  have  spoken, 
the  Chinese  admit  five  elements,  namely:  water,  wood,  fire,  earth,  and 
metal.  The  following  is  the  order  in  which  they  are  supposed  to  be 
produced ;  water,  the  source  of  all  fertility,  engenders  wood  or  plants  : 
these,  when  they  are  dry,  inflame  and  cause  fire,  or  ignited  spirits.  The 
remains  of  the  fire,  or  the  ashes,  form  the  earth,  which  in  its  turn  pro- 
duces the  metals. 

The  Chinese  physicians  imagine  a  multitude  of  odd  connections  be- 
tween the  viscera  of  the  human  body,  the  elements,  the  seasons  of  the 
year,  the  stars,  colors,  variations  of  the  pulse,  and  numerous  other 
objects  no  less  dissimilar.     We  give  but  one  example. 

The  heart,  they  say,  is  analogous  to  fire,  to  the  planet  Mars,  to  sum- 
mer, to  spring,  and  to  southern  climes.  It  comes  from  the  liver,  begets 
the  spleen  and  the  stomach,  is  antipathic  with  the  kidney,  and  receives 
no  injurious  influence  from  its  contact  with  the  lungs. 

The  natural  pulse  of  the  heart  is  bounding,  like  a  full  swelling  wave. 
Explored  lightly  with  the  finger,  it  appears  large  and  free ;  but,  under 
a  strong  pressure,  it  becomes  feeble  and  fugitive.  It  has  for  an  antag- 
onist, the  deep-seated  pulse.  During  the  spring-time,  the  pulse  of  the 
heart  is  like  a  tense  cord ;  in  summer  it  is  more  developed  and  becomes 
exuberant ;  in  autumn  it  appears  as  if  floating ;  in  winter  it  is  rather 
quiet. 

The  heart  has  a  predominant  influence  on  the  blood,  the  forehead,  the 
tongue,  and  the  palm  of  the  hands.  It  is  sympathetic  with  odors,  red 
colors,  such  as  the  comb  of  the  cock,  and  lively,  gay  sounds,  laughing, 
the  exhalation  of  a  roast,  bitter  taste,  and  sweat.  Excess  of  joy,  heat, 
inquietude,  fixed  attention,  and  bitters,  injure  the  heart  and  the  blood, 
A  black  tongue,  which  cannot  be  run  out  of  the  mouth,  and  swelling  in 
the  palms  of  the  hands,  are  concomitant  signs.  Eolling  the  eyes  back- 
ward, with  a  pulse  like  a  floating  cord,  announce  the  destruction  of  that 
organ. 

Some  writers  have  been  willing  to  accord  to  the  Chinese  the  honor  of 
a  knowledge  of  the  circulation  of  the  blood,  but  we  shall  see  that  they 
mean  by  this  word  a  phenomenon  entirely  difi"erent  from  that  to  which 
we  apply  it.  They  think  that  the  spirits  and  the  blood,  both  vehicles  of 
heat  and  vital  humidity,  run  through  all  parts  of  the  body  in  twenty- 
four  hours.  This  diurnal  circulation,  they  say,  commences  in  the  lungs, 
at  three  o'clock  in  the  morning,  and  ceases  next  day  at  same  place,  and 
at  the  same  instant.  The  knowledge  of  the  canals  through  which  this 
is  effected,  constitutes,  in  the  eyes  of  Chinese  physicians,  the  fullness 
of  anatomical  science.  They  count  six  canals  which  pass  directly 
from  above  downward,  and  an  equal  number  which  return  from  below 


42  PRIMITIVE   PERIOD. 

upward ;  eight  run  transversely,  and  fifteen  obliquely.  The  plates  that 
Pleyer  has  placed  in  his  memoirs,  suffice  to  give  an  idea  of  the  grotesque 
manner  in  which  the  Chinese  represent  these  imaginary  canals,  and  the 
principal  viscera  of  the  human  body. 

Such  is  a  summary  o£  the  doctrine  contained  in  the  Nuy'  Kim'.  The 
physicians  regard  it  as  an  infallible  guide,  and  when  they  are  mistaken 
in  their  prognostics,  which  very  frequently  happens,  far  from  suspecting, 
in  any  respect,  the  excellency  of  the  precepts  of  the  Nuy'  Kim',  they 
rather  think  that  they  have  not  well  understood,  or  not  properly  fol- 
lowed them. 

These  physicians  relate  that  one  of  their  ancient  emperors  directed 
the  dead  bodies  of  criminals  to  be  opened,  that  the  interior  arrangement 
of  the  body  might  be  studied.  This  tradition  is  questionable,  for  it 
appears  certain  that,  from  time  immemorial,  the  Chinese  have  not 
allowed  researches  on  dead  bodies,  whether  of  men  or  animals,  which 
explains  their  profound  ignorance  on  the  structure  of  our  organs,  and 
the  long  reign  of  a  physico-pathologic  system  so  replete  with  ridiculous 
hypotheses  and  glaring  errors.  Nevertheless,  one  of  their  emperors 
ordered  the  translation  by  the  Jesuit  Father  Parrenin,  of  the  anatomical 
treatise  of  Dionis;  but  this  work,  though  one  of  the  best,  previous  to 
the  last  century,  is.  up  to  the  present  time,  a  dead  letter,  a  light  under 
the  bushel,  to  the  Chinese  doctors.-' 

They  divide  all  diseases  into  two  great  classes,  accordingly  as  they 
attack  an  organ  adjoining  the  vital  center,  such  as  the  heart,  the  lung,  the 
stomach,  or  an  organ  separated  from  the  fictitious  center,  as  the  kidneys, 
the  bladder,  the  extremities  on  the  skin.  They  have,  also,  multiplied  to 
infinity,  the  nosological  scale.  Thus,  they  count  forty-two  kinds  of  vari- 
ola, distinguished  from  each  other  by  obscure  and  insignificant  charac- 
teristics. They  have  a  variola  of  the  alae  of  the  nose,  and  of  the 
circumference  of  the  eyes,  one  which  is  characterized  by  pimples,  sur- 
rounded by  a  red  circle ;  others,  whose  pustules  are  acuminated  or  flat- 
tened, or  black,  or  transparent,  etc. 

Notwithstanding  the  egregious  errors  of  these  pathological  classifica- 
tions, and  the  absurdity  of  their  theories,  the  physicians  of  China  must 
have  been  able  to  make,  in  the  space  of  four  thousand  years,  some  precious 
observations  on  the  march,  symptoms  and  prognosis  of  diseases,  and 
some  discoveries  of  the  means  for  their  cure.  It  is,  therefore,  probable 
that  there  may  be  found,  in  their  voluminous  repositories,  as  some 
judicious  writers  believe,  a  quantity  of  useful  material,  both  for  the 

•^'Pere  Dionis  was  Professor  of  Anatomy  and  Surgery  at  the  Jardin  du  Hoi,  in 
1673. 


MEDICINE    OF   THE   CHINESE.  4S 

history  and  treatment  of  certain  morbid  affections/-'  It  is  known,  for 
example,  that  inoculation,  by  the  variolic  virus,  vpas  generally  cm- 
ployed  by  them  a  long  time  before  it  was  known   n  Europe. 

The  Chinese  appear  to  have  cultivated,  particularly.  Materia  Medica 
and  Pharmacology,  if  we  may  judge  by  the  number  of  works  they  have 
written  on  these  subjects.  They  possess  more  than  forty  of  them,  of 
which  one  alone,  the  most  complete  of  all,  is  composed  of  fifty-two 
quarto  volumes.  But  the  extracts  that  have  been  made  from  them, 
only  contain  a  long  enumeration  of  substances  employed  in  Medicine, 
without  describing  the  natural  characteristics  by  which  they  or  thei) 
preparations  might  be  recognized  by  us. 

There  are  no  apothecaries  in  that  country.  The  physicians  are 
accustomed  to  prepare  and  administer  their  own  remedies.  Some  of  the 
most  distinguished,  however,  simply  give  a  formula,  and  leave  to  other? 
of  less  rank,  the  task  of  executing  it.  They  daily  retail  in  the  mar- 
kets considerable  quantities  of  drugs,  and  various  compositions,  which 
are  boasted  to  have  an  efficacy  against  a  host  of  diseases.  One  of  the 
most  famous  is  the  ginsengf  root.  Incomparable  virtues  are  attributed 
to  it ;  among  others,  those  of  reanimating  the  vital  forces,  putting  off 
the  infirmities  of  age,  and  prolonging  the  life  beyond  the  ordinary 
term.  The  people  who  believe  in  its  fabulous  properties,  buy  it,  lite- 
rally, with  its  weight  of  gold.  Their  frightful  abuse  of  opiates  is  also 
well  known. 

Having  no  anatomical  knowledge,  surgery  is  uncultivated,  so  that  it 
may  be  said  that  in  China  this  branch  of  medical  science  has  neve? 
passed  its  infancy.  No  one  dare  attempt  a  bloody  operation,  however 
slight.  The  reduction  of  hernia  is  unknown,  and  a  cataract  ie 
regarded  as  beyond  the  resources  of  Art ;  even  blood-letting  is  wholly 
unpracticed.  On  the  other  hand,  they  frequently  employ  cups  and 
acupuncture,  which  they  execute  with  needles  of  gold  or  silver ;  fomen- 
tations, plasters  of  all  kinds,  lotions,  and  baths.  They  make  much 
use  of  fire,  by  means  of  moxas,  or  red-hot  buttons.  They  have  evee 
their  magnetizers,  whom  the  author  of  the  "  Chinese  Letters  "  compares 
to  the  convulsionists  of  Saint  Medard.  In  a  word,  their  therapeutics, 
whether  internal  or  external,  recalls  that  of  the  Europeans  during  the 
darkest  period  of  feudal  times. 

"  See  the  excellent  "Dissertation  sur la Me'decine  des  Chinois,"  by  M.  Lepage. 
Paris,  181.5,  and  the  article  of  the  Diet,  des  Sciences  Medicales,by  M.  Brichet«au, 
8ur  "  Medecine  des  Chinois." 

j-See  Merat  et  Delens,  "  Dictionnaire  Universel  de  Matiere  Mddicale."  Paris, 
1831,  t.  Ill,  p.  356. 


44  PRIMITIVE   PERIOD. 

Formerly,  there  existed,  at  Pekin,  imperial  schools  of  Medicine,  and 
no  one  could  then  practice  Medicine  without  having  served  an  appren- 
ticeship, and  given  proof  of  his  capacity.  Beside,  it  is  said,  there  was, 
for  each  district  of  six  leagues  square,  a  physician  chosen  to  instruct 
those  who  were  required  to  serve  the  inhabitants  of  the  country.  At 
this  time,  there  is  no  such  organization,  every  one  has  the  right  of 
selling,  prescribing,  and  administering  remedies,  without  any  exami- 
nation, authorization,  or  restraint. 

How  inconceivable  is  the  stupid  indifference  of  a  government  which 
requires  no  guarantee  of  knowledge  or  morality  on  the  part  of  individ- 
uals who  are  every  moment  the  arbiters  of  the  health  and  the  life  of 
their  fellows,  whose  profession  renders  them  the  depositories  of  the 
most  sacred  family  secrets,  by  giving  them  easy  access  to  persons  of  all 
sexes,  ages,  and  conditioDS.  It  is  said  that  physicians  in  China  are, 
generally,  but  little  respected,  nor  do  they  deserve  more  consideration, 
excepting  those  in  whom  the  profession  is  hereditary.  This  deep  dis- 
credit into  which  the  Art  of  Healing  is  fallen,  or  rather  of  those  who 
cultivate  it,  need  not  astonish  us ;  it  is  the  natural  result  of  the 
absence  of  all  law  regulating  the  practice  of  Medicine.  The  same  is 
true  among  all  nations  under  analogous  circumstances,  as  this  historj- 
will  prove.  We  might  refer  the  reader,  by  anticipation,  to  the  picture 
that  Galen  has  drawn  of  the  deplorable  effects  of  the  medical  anarchy 
which  reigned  at  Eome  in  his  time  ;  we  might  also  refer  to  the  low 
state  of  Medicine  during  the  first  ages  of  the  feudal  period,  before  the 
establishment  of  universities.  But,  without  searching  so  far  back  into 
the  annals  of  the  race,  it  will  suffice  to  place  before  the  eyes  of  the 
reader  the  reflections  which  such  a  state  of  things  suggested  to  the 
author  of  the  Medical  Law  of  the  19th  of  March,  1803. 

"Men  united  in  society,"  says  Thouret,  "have,  in  all  times,  been 
subject  to  evils  growing  out  of  their  intercourse,  which  have  often 
caused  philosophers  to  think  that  this  intercourse  itself  was  more  inju- 
rious than  useful  to  humanity.  The  utility  of  this  consolatory  Art  has 
been  felt  among  all  nations  and  in  all  ages.  There  exists  no  govern- 
ment which  does  not  render  it  a  favorable  support,  and  which  is  not 
interested,  more  or  less,  in  its  progress.  Anarchy  only,  which  respects 
no  institution,  could  ignore  the  importance  of  the  Healing  Art;  it 
belongs  to  every  reformative  government  to  restore  to  this  branch  of 
instruction  its  ancient  splendor  and  advantageous  results.  Profoundly 
penetrated  with  the  necessity  of  re-establishing  order  in  the  exercise  of 
a  profession  which  interests  essentially  the  security  of  the  lives  of  citi- 
zens, the  government  presents  to  you  a  project  of  a  law,  having  for  its 
object  the  regulation  of  the  practice  of  this  salutary  Art. 


MEDICINE    OF   THE   CHINESE.  45 

"  Since  the  decree  of  the  18th  of  August,  1792,  which  suppressed  the 
universities,  faculties,  and  learned  corporations,  there  is  no  longer  any 
regulation  for  the  privilege  of  practice  of  Medicine  or  Surgery.  The 
most  complete  anarchy  has  taken  the  place  of  the  former  organizations. 
Those  who  have  studied  the  Art  find  themselves  confounded  with  those 
who  have  not  the  least  notion  of  it.  The  lives  of  citizens  are  in  the 
hands  of  greedy  and  ignorant  men  ;  the  most  dangerous  empiricism, 
and  shameless  charlatanism  impose,  everywhere,  upon  credulity  and 
good  faith.  No  proof  of  knowledge  and  skill  is  required ;  the  country 
and  cities  are  equally  infested  with  quacks,  who  deal  out  poison  and 
death  with  an  audacity  that  our  present  laws  can  not  repress.--^  The 
most  murderous  practices  have  usurped  the  place  of  the  principles  of 
the  Art  of  Midwifery.  Impudent  barbers  and  bonesetters  assume  the 
title  of  "  health  officers,"  to  cover  their  ignorance  and  greediness.  Never 
has  the  list  of  secret  remedies,  always  dangerous,  been  so  extensive  as 
since  the  suppression  of  the  faculty  of  Medicine.  The  evils  are  so 
grave  and  so  multiplied,  that  many  mayors  iave  sought  a  means  of 
remedying  them,  by  establishing  a  kind  of  jury,  charged  with  power  to 
examine  the  men  who  wish  to  practice  Medicine  in  the  departments. 
But  these  local  institutions,  independently  of  the  variety  of  tests  of 
qualification  that  they  have  adopted,  open  the  door  to  new  abuses, 
arising  from  the  superficial  nature  of  the  examinations,  and  sometimes 
from  a  still  more  impure  source.  The  Minister  of  the  Interior  has 
been  compelled  to  annul  the  permits  of  several  mayors,  from  the  abuses 
and  irregularities  they  connived  at.  It  is,  then,  urgent  to  destroy  all 
these  evils  at  once,  and  to  organize  a  uniform  and  regular  mode  of 
examination  and  reception  for  those  who  wish  to  devote  themselves  to 
the  cure  of  the  sick."f 

V.       MEDICINE    AMONG    THE    GREEKS    DURING    THE    PRIMITIVE    PERIOD. 

Greece,  which  will,  hereafter,  furnish  us  the  most  interesting  and  best 
preserved  debris  of  the  Healing  Art  of  the  ancients,  does  not  give  us,  in 
regard  to  the  history  of  this  Science,  during  the  ages  that  precede  the 
Trojan  War,  anything  more  than  dim  lights  and  tradition  stamped  with 
a  fabulous  character,  and  often  borrowed  from  other  nations.  The 
learned  and  modest  Daniel  Leclerc,  details  at  great  length  her  medical 
mythology  ;  he  names  more  than  thirty  gods  or  goddesses,  heroes  or 
heroines,  who  were  supposed  to  have  invented  or  cultivated,  with  distinc- 
tion, some  of  the  branches  of  Medicine.     He  interrogates,  successively, 

*  These  remarks  are  very  applicable  to  most  of  our  state  governments, 
f  "Jurisprudence  de  la  Me'decine,  de  la  Chirurgie  et  de  la  Pharmacie  en  France," 
by  Adolphus  Trebuchet.     Paris,  1834,  page  408,  etc. 


46>  PRIMITIVE    PERIOD. 

history,  poetry,  chronicles,  and  inscriptions ;  he  neglects  nothing  in  the 
hope  of  shedding  some  light  on  the  chaos  of  improbable  or  contradictory 
traditions ;  but  his  praiseworthy  though  unfruitful  efforts  have  not  drawn 
from  them  any  valuable  truths,  nor  well  established  facts.  Sprengel, 
who  undertook  the  same  task,  two  hundred  years  later,  with  germanic 
patience,  has  only  succeeded  in  displaying  a  vast  and  confused  erudi- 
tion. ••'  It  would  then  be  temerity  on  my  part  to  enter  into  a  labyrinth 
where  men  of  such  great  wisdom  have  lost  themselves.  I  shall  content 
myself  by  extracting  from  these  fabulous  legends  a  few  anecdotes,  and 
some  of  the  best  credited  names,  that  have  become  common  knowledge, 
and  which  a  physician  ought  to  know,  or  suffer  the  imputation  of  ignor- 
ance of  the  history  of  his  Profession. 

Melampus  is  the  first  of  the  Greeks,  following  the  chronological  order, 
who  immortalized  himself  by  extraordinary  cures,  and  to  whom,  from 
gratitude,  altars  were  erected.  He  lived  in  the  times  of  Proetus,  king 
of  Argos,  nearly  two  hundred  years  before  the  Trojan  war.  He  is  said 
to  have  cured  Iphiclus  of  impotency,  by  giving  him  the  rust  of  iron. 
But  this  is  difficult  to  accredit,  when  we  are  assured  that  Iphiclus  took 
pai't  in  the  Argonautic  expedition,  one  hundred  and  fifty  years  later. 

The  most  famous  of  the  cures  attribut  d  to  Melampus.  were  those  of 
the  daughters  of  Proetus.  These  princesses,  who  had  taken  vows  of 
celibacy,  became  subject  to  fits  of  hysteria  or  monomania,  during  which, 
they  imagined  themselves  transformed  into  cows,  and  would  leave  the 
palace  to  run  wild  in  the  forests,  lowing  like  those  animals.  This  ner- 
vous affection  was  communicated,  sympathetically,  to  other  women  of 
Argos,  who  followed  the  Proetides,  imitating  their  deranged  conduct. 
The  shepherd,  Melampus.  having  observed  that  his  goats  purged  them- 
selves by  eating  white  hellebore,  gave  his  young  patients  milk  in  which 
this  plant  was  infused,  and  then  caused  some  robust  young  boys  to  chase 
them  over  the  fields  until  they  were  thoroughly  fatiguxl.  Then  he  en- 
chanted them,  and  made  them  bathe  in  a  fountain  of  Arcadia,  called  Cli- 
torian,  which  completed  their  cure.  In  pay  for  so  great  a  service, 
Proetus  offered  to  Melampus  the  hand  of  one  of  his  daughters  with  the 
third  of  his  kingdom.  The  herdsman  showed,  on  this  occasion,  as  much 
fraternal  affection  as  medical  perspicacity,  for  he  would  not  accept  the 
offer  of  the  monarch,  except  on  condition  that  his  brother  Bias  should 
have  a  reward  equal  to  his  own. 

Chiron  is  less  illustrious  in  the  great  acts  that  he  performed  than  in 
the  pupils  he  reared.     He  held  his  school  in  a  grotto  in  Thessaly,  and, 

^'See  also  "  I'Histoire  de  la  Chirurgie,"  commenced  bj  Dujardin,  and  continued 
by  Peyrilhe.     Paris,  1774-1780.    2  vols,  in -Ito. 


MEDICINE   OF   THE   GREEKS.  47 

if  the  chronicle  may  be  believed,  no  philosopher  of  antiquity,  no  pro- 
fessor in  modern  times,  could  count  in  his  audience  as  many  celebrities 
as  the  Centaur  saw  in  his  cave.  A  majority  of  the  heroes  who  distin- 
guished themselves  at  the  capture  of  the  fleece  of  gold,  or  in  the  Trojan 
war,  boasted  of  having  been  his  disciples.  Among  these  are  enumerated 
Hercules.  Jason,  Theseus,  Castor  and  Pollux,  the  subtle  LTysses,  the 
fiery  Diomedes.  the  prolix  Xestor.  the  pious  Eneas,  and  the  invincible 
Achilles.  The  hermit,  it  is  said,  taught  them  philosophy,  music,  astron- 
omy, the  military  art,  political  science,  and  medicine.  He  cured  Phoenix, 
son  of  Amyntor.  of  a  blindness  supposed  to  be  incurable,  and  his  renown 
for  the  treatment  of  ulcers  was  so  great,  that  the  name  of  C'hironians  was 
given  to  those  which  resisted  all  curative  means,  and  presented  a  malig- 
nant appearance.  The  etymologists  derive  the  word  Centaureus,  from 
Centaur,  in  order  to  remain  true  to  the  mythological  tradition,  and 
doubtless  from  having  no  better  substitute.  Finally,  it  is  said,  that 
this  hero  or  demigod,  so  skillful  in  dressing  wounds  of  all  kinds,  met 
his  death  from  the  wound  of  an  arrow,  poisoned  by  the  blood  of  the 
hydra  of  Lerna. 

Esculapius,  of  all  the  disciples  of  Chiron,  was  the  most  eminent,  in  a 
medical  point  of  view.  He  passed  for  the  son  of  Apollo,  by  the  nymph 
Coronis.  Several  cities  of  Greece  have  contended  for  the  honor  of  his 
birthplace  ;  but  the  general  opinion  is,  that  he  was  born  at  Epidaurus 
a  city  of  Argolis,  where  he  had  a  temple  and  a  famous  oracle.  The 
twins,  Castor  and  Pollux,  were  anxious  <liat  he  should  accompany  the 
Argonautic  expedition,  which  shows  that  he  was  famous  at  that  epoch, 
as  a  physician,  or  rather,  as  a  surgeon. 

The  Esculapius  of  the  Hellenists,  being  of  a  date  posterior  to  the 
Hemies  of  the  Egyptians,  and  these  two  characters,  having  between  them 
many  traits  of  resemblance,  certain  authors  have  thought  that  the 
latter  might  probably  only  be  a  copy  of  the  former.  They  have  denied 
the  indivi'luality  of  the  god  of  Epidaurus,  and  have  accused  him  of 
being  a  twin  brother  of  his  colleague  of  Memphis.  Leclerc,  after 
having  deeply  studied  this  grave  question,  in  every  respect,  has  not 
dared  to  decide  it.     My  views  correspond  with  his. 

However  this  may  be,  Esculapius  obtained  in  antiquity,  nearly  a 
universal  veneration.  His  worship,  which  passed  from  the  Greeks  to 
the  Romans,  extended  into  all  countries,  penetrated  by  the  arms  of  these 
two  nations.  We  shall  speak  elsewhere  of  the  principal  temples  erected 
to  his  honor,  of  the  priests  that  were  connected  with  them,  and  the 
progress  they  made  in  Medical  Science.  For  the  present,  wc  shall  con- 
tent ourselves  with  relating  some  of  the  cures  attributed  to  him,   and 


48  PRIMITIVE    PERIOD. 

glance  at  the  opinions  of  the  ancients,  relative  to  his  manner  of  treat- 
ing diseases. 

It  is  said  he  brought  from  death  to  life,  Hippolytus,  son  of  Theseus, 
a  Capaneus,  a  Lycurgus,  an  Eryphile,  and  many  others.  Pluto,  god  of 
Hell,  alarmed  to  see  the  number  of  new  arrivals  to  his  gloomy  kingdom, 
diminishing  day  by  day — complained  to  Jupiter,  who  destroyed  the 
audacious  healer.  On  this  account  says  a  wit,  the  modern  children  of 
Esculapius  abstain  from  performing  prodigies.  But  the  witty  writer 
forgot,  that  there  has  always  existed,  and  now  exists,  a  class  of  self- 
styled  physicians,  who  have  never  ceased  to  perform  miracles.  They 
are  called,  according  to  circumstances,  charlatans,  quacks,  theosophs, 
thaumaturgs,  etc.  Such  were,  among  others,  Asclepiades  of  Bithynia, 
who  resuscitated  a  corpse,  in  a  public  place  in  Kome,  in  open  day ; 
Paracelsus,  who  boasted  of  keeping  in  a  vial,  a  living  little  man,  man- 
ufactured by  himself;  Piobert  Fludd,  the  oracle  of  modern  theosophs; 
Mesmer,  the  magnetizer,  and  their  adepts. 

In  regard  to  the  method  which  Esculapius  followed,  in  the  treatment 
of  diseases,  as  well  as  to  all  else  relating  to  this  god,  we  possess  no  doc- 
uments, entitled  to  much  credit.  The  poet  Pindar,  who  lived  seven  or 
eight  hundred  years  later,  is  the  first  to  describe  it  in  the  following 
terms:  "Esculapius,"  says  he,  "  cured  the  ulcers,  wounds,  fevers  and 
pains  of  all  who  applied  to  him,  by  enchantments,  calming  potions,  in- 
cisions, and  by  external  applications."-' 

The  greatest  number  of  writers,  after  the  Boeotian  poet,  such  as  Galen, 
Plutarch,  Pausanias.  Pliny  and  others,  have  reiterated  the  same  views. 
Plato,  comparing  the  practice  of  Esculapius,  with  that  of  his  cotempo- 
raries,  gives  the  preference  to  the  former,  for  reasons  which  deserve  to 
be  reported. 

In  the  third  dialogue  on  the  republic,  Socrates,  when  interrogated  by 
(ilaucus,  responds  as  follows: 

"Is  it  not  a  shameful  thing  to  be  compelled  to  call  upon  a  physician, 
not  for  the  cure  of  wounds,  or  the  diseases  of  the  seasons ;  but  for  such 
as  are  produced  by  the  indulgent  life  I  have  described,  which  fills  us 
with  humors  and  unhealthy  vapors,  like  swamps;  thus  obliging  the 
worthy  sons  of  Esculapius,  to  invent  such  new  names,  as  catarrhs, 
fluxions,  etc." 

"  Indeed,  Socrates,  these  are  new  and  extraordinary  names  of  dis- 
eases." 

"Yes!  such  as  did  not  exist  in  the  times  of  Esculapius,  I  think,  and 
what  leads  me  to  believe  it,  is,  that  his  sons  (Machaon  and  Podalirius), 

"'  Third  Pythian  Ode. 


MEDICINE   OF  THE   GREEKS.  49 

during  the  siege  of  Troy,  did  not  blame  tte  women  who  gave  as  a  bever- 
age to  the  wounded  Eurypylus,  Pramnian  wine,  upon  which  she  had 
sprinkled  flour  and  grated  cheese,  both  of  which  have  an  inflammatory 
tendency;  nor  Patroclus,  who  cured  wounds  with  herbs." 

"It  was  strange,  nevertheless,  to  give  that  beverage  to  a  wounded 
man." 

"It  was  not,  if  you  reflect  that  before  Herodicus,  the  art  of  treating 
and  curing  diseases,  as  is  now  attempted,  was  not  put  in  practice,  by  the 
disciples  of  Esculapius.  Herodicus  was  the  master  of  a  Gymnasium  ; 
becoming  a  valetudinarian,  he  combined  gymnastics  and  medicine,  by 
which  combination  he  tormented  himself,  and  many  others  after  him." 

"In  what  way?" 

"By  producing  a  slow  death,  for  as  his  disease  was  mortal,  he  followed 
it  step  by  step,  without  being  able  to  cure  it,  and  neglecting  everything 
else  to  take  care  of  himself.  Distressed  by  anxieties,  if  he  varied  ever  so 
little  from  his  regimen,  by  force  of  art  he  reached  old  age,  by  a  life 
of  real  agony." 

"His  art  rendered  him  an  excellent  service!" 

"He  well  merited  it,  for  not  having  seen,  that  if  Esculapius  did  not 
teach  to  his  descendants  that  system  of  Medicine,  it  was  neither  from 
ignorance,  or  defect  of  understanding,  but  because  he  knew,  that  in 
every  well-ordered  government,  each  citizen  has  a  task  to  fulfill,  and 
that  no  one  has  leisure  to  pass  his  life  in  sickness,  and  in  taking  care  of 
himself.  If  we  see  the  absurdity  of  this  method,  for  artisans,  we  see  it 
none  the  less  for  the  rich,  and  the  pretended  happy  of  the  world." 

"  Explain  yourself?" 

"Let  a  carpenter  be  sick,  he  is  benefited  by  a  physician,  who  relieves 
him  by  a  vomit  or  a  purge,  or  rids  him  of  his  disease  by  fire  or  steel,  but 
if  one  comes  to  him  and  prescribes  a  long  regimen,  enveloping  his  head 
in  cloths,  and  other  similar  treatments,  he  very  soon  must  say,  that  he 
has  no  time  to  be  sick,  and  that  there  is  no  advantage  in  living  thus, 
occupying  himself  with  his  disease,  and  neglecting  his  labor  which 
awaits  him.  He  says,  away  with  such  medical  treatment,  and  resuming 
his  ordinary  style  of  living,  recovers  his  health,  and  goes  to^work  again; 
or,  if  his  system  can  not  resist  the  disease,  death  comes  in  to  relieve 
him  from  his  embarrassment.  These  are,  according  to  my  opinion,  the 
considerations  that  led  Esculapius  to  prescribe  a  treatment,  suitable 
only  for  the  diseases  of  persons  of  strong  constitutions,  and  good  habits ; 
and  to  limit  his  remedies  to  potions  and  incisions,  without  changing  their 
manner  of  living,  wishing  not  to  harm  society.  But  in  regard  to  those  rad- 
ically unsound,  he  was  not  willing  to  assume  the  responsibility  of  prolong- 
ing their  lives  and  sufferings,  by  injections  or  ejections,  given  according 


50  PKIMITIVE   PERIOD. 

to  circumstances,  and  thus  put  them  in  a  condition,  to  beget  other  beings, 
destined  most  likely  to  inherit  their  diseases.  He  thought  that  it  was 
not  required  to  treat  those  who  could  not  fulfill  the  career  marked  out  by 
Hature,  because  it  was  neither  advantageous  to  themselves,  nor  to  the 
state." 

"You  make  a  politician  of  Esculapius." 

"It  was  evident  that  he  was  one,  and  his  children  furnish  the  proof 
of  it;  for  while  they  fought  with  intrepidity  under  the  walls  of  Troy, 
they  practiced  Medicine,  as  I  have  just  stated."  ■ 

The  above  argument,  tending  to  prove  that  Medical  Science  must  not 
be  occupied  with  valetudinarians  or  individuals  of  a  debilitated  consti- 
tution, is  destroyed  by  the  simple  remark  of  one  of  the  interlocutors, 
"  You  make  a  politician  of  Esculapius."  It  is  certainly  wrong  in 
Socrates,  or  Plato,  as  explained  by  him,  to  desire  that  the  physician 
sacrifice  the  sentiments  of  his  nature,  and  the  right  of  suffering  human- 
ity, to  the  exigencies  of  an  unpitying  political  economy.  No,  whatever 
this  sage  may  say,  a  physician  must  not  ask  himself,  if  the  preservation 
of  the  individual  who  claims  his  services  is  likely  to  be  burdensome 
or  useful  to  the  State.  In  ancient  republics,  such  atrocious  patriotism 
was  praised,  but  modern  civilization  repudiates  it.  It  does  not  permit 
the  physician  to  consider  any  such  question  in  regard  to  his  patients ; 
he  must  do  all  he  can  for  them. 

Such  is  the  view  that  the  medical  corps  of  France  has  held  of  its 
duties,  under  all  phases  of  our  internal  dissensions.  A  striking  proof 
of  this  has  been  given  but  very  recently.  It  may  be  remembered  that, 
at  the  close  of  one  of  the  bloody  contests  in  the  capital,  which  took 
place  during  the  first  years  of  the  reign  of  Louis-Philippe,  a  chief  of 
police  endeavored  to  force  the  physicians  to  tell  the  names  of  the  wounded 
whom  they  attended.  The  magistrate  thought  this  an  honest  way  of  dis- 
covering the  enemies  of  the  government ;  but  the  public,  as  well  as  the 
medical  corps,  saw  in  this  a  shameful  abuse  of  confidence,  the  espio- 
nage hiding  itself  in  the  cloak  of  the  minister  of  benevolence. 

Policy  was  obliged  to  bend  before  the  morale,  and  this  is  not  one  of 
the  least  glories  of  our  epoch.  This  would  not  have  taken  place  in  the 
time  of  Plato,  for  the  opinion  which  we  combat  here,  and  of  which  the 
philosopher  has  made  himself  the  echo,  appertains  much  less  to  him 
than  to  his  age,  it  reigned  in  all  the  ancient  republics  prior  to  the 
advent  of  Christianity. 

Machaon  and  Podalirius  touched  the  limits  that  separate  mythology 
from  history ;  these  two  personages  participate  in  this  double  charac- 

*  De  la  Republic,  Book  III,  translation  of  M.  Cousin,  p.  167,  et  suiv. 


MEDICINE   OF   THE   GREEKS.  51 

ter ;  their  biography  is  a  mixture  of  fabulous  and  probable  narrations. 
Their  existence,  for  example,  can  not  be  considered  doubtful,  for  the 
Homeric  songs  and  other  ancient  writings,  agree  in  representing  them 
as  valiant  captains  and  skillful  physicians,  who  took  an  active  part  in 
the  siege  of  Troy,  but  the  statement  of  their  genealogy  does  not  inspire 
us  with  the  same  confidence.  They  are  said  to  be  the  sons  of  Escula- 
pius.  and  we  know  that  the  reality  of  this  famous  individual  is  exceed- 
ingly problematical.  Beside,  the  words,  children  of  Esculapius,  are 
often  employed  figuratively  by  ancient  authors,  to  designate  men  who 
devoted  themselves  to  the  medical  profession. 

Machaon  was  regarded  as  the  elder  of  the  two  brothers.  He  treated 
Menelaus,  when  that  prince  was  treacherously  wounded  by  Pindar. 
He  cured,  also,  Philoctetes,  who  was  lame  from  a  wound  which  he 
inflicted  upon  himseif,  by  letting  fall  upon  his  foot  one  of  the  arrows 
of  Hercules.  This  illustrious  surgeon  met  his  death  in  a  singular  com- 
bat under  the  walls  of  Troy. 

Podalirius  survived  him,  and  assisted  in  the  ruin  of  the  kingdom  of 
Priam,  but  on  his  return  he  was  cast  by  a  tempest  on  the  shore  of  Ca- 
ria.  A  shepherd  rescued  him,  and  learning  that  he  was  a  physician, 
he  conducted  him  to  Dametus,  the  kin^  of  the  country,  whose  daughter 
had  lately,  accidentally^  fallen  from  the  top  of  the  house.  She  was 
insensible  and  motionless,  and  the  attendants  already  supposed  her 
dead,  but  this  skillful  surgeon  bled  her  from  both  arms,  and  had  the 
happiness  of  restoring  her  life. 

Here  is  the  first  example  of  bleeding  practiced  for  the  purpose  of  a 
cure ;  unhappily,  it  is  not  very  authentic.  Stephen,  of  Byzance,  who 
reports  it,  wrote  in  the  fifth  century,  nearly  1600  years  after  the  event, 
and  he  does  not  indicate  the  source  whence  he  obtained  it.  However, 
the  habit  of  bloodletting  goes  back  far  beyond  the  era  of  Hippocrates, 
for  he  speaks  of  it,  in  several  places,  as  a  common  practice  in  his  time. 

The  other  members  of  the  family  of  Esculapius  are  all  fictitious 
beings,  whose  symbolical  names  only  remind  us  of  some  attribute  in 
Medicine.  Thus,  the  name  of  Epion,  his  wife,  is  derived  from  a  Greek 
word,  which  signifies  to  quiet ;  those  of  Hygeia  and  Panacea,  his 
daughters,  express,  the  one  health,  and  the  other,  a  remedy  for  all 
diseases. 

Moreover,  many  of  the  gods  and  goddesses  of  Olympus  assumed  the 
honor  of  fulfilling  some  medical  function.  Apollo,  or  Phoebus,  the 
father  of  Esculapius,  usurped  nearly  everything.  Under  the  name  of 
Pseon,  he  assumed  the  privilege  of  exciting  or  appeasing  epidemics.  It 
is  well  known  that  Juno  presided  at  accouchements,  and  took  at  those 
times  the  surnames  of  Lucina,  Ilithyia,  or  Natalis.     In  short,  by  the 


52  PRIMITIVB   PERIOD. 

ingenious  connection  of  many  passages  in  the  Iliad  and  the  Odyssey, 
M.  Malgaigne  indicates  that  Apollo  was  considered  as  the  author  of  all 
the  natural  deaths  among  men,  and  Diana  of  those  among  women. 

At  an  epoch  when  yet  the  earliest  inhabitants  of  Greece,  called 
Pelages,  lived  on  the  acorns  of  their  forests,  and  were  covered  with  the 
skins  of  wild  beasts,  making  their  homes  in  caves  ;  Egypt,  Phenicia, 
and  Chaldea  already  rejoiced  in  the  blessings  of  an  advanced  civiliza- 
tion. The  emigration  of  successive  parties  from  Sais,  Tyre,  and  Mem- 
phis, carried  to  the  hellenic  peninsula  the  germs  of  the  arts  and  sci- 
ences. Inachus,  the  victim  of  a  revolution,  conducted  to  Greece  the 
first  Egyptian  colony,  and  laid  the  foundation  of  the  city  of  Argos, 
1856  years  before  Christ.  Several  ages  later,  Cecrops,  obliged  to  fly 
from  the  banks  of  the  Nile,  landed  on  the  shores  of  Attica,  and  became 
the  founder  of  Athens,  which  he  consecrated  to  Minerva,  Cadmus 
came  from  Tyre  with  a  company  of  Phenicians,  and  established  himself 
in  Boeotia.     He  built  the  walls  of  Thebes,  which  citadel  bore  his  name. 

The  major  part  of  the  aborigines  embraced,  either  from  taste  or  com- 
pulsion, the  habits  of  civilized  life,  and  adopted  the  worship  and  laws 
of  the  new  comers,  while  a  certain  number,  still  preferring  the  indepen- 
dence and  idleness  of  a  nomadic  life,  formed  themselves  into  wandering 
bands  that  devastated  the  country,  driving  off  the  flocks,  and  despoil- 
ing and  murdering  travelers.  The  founders  of  the  new  colonies  made 
a  war  of  extermination,  and  the  first  men  who  signalized  themselves  by 
victories  over  the  chiefs  of  the  brigands,  or  the  savage  monsters  of  the 
wild  country,  were  considered  as  heroes,  and  benefactors  of  humanity. 
Gratitude  mingled  their  praise  with  that  of  the  gods.  Gradually  the 
recollection  of  these  events  became  dim,  because  the  narrations  were 
not  committed  to  writing.  The  adventures  of  these  earthly  heroes 
were  confounded  with  those  of  the  gods  imported  from  foreign  countries. 
Names  and  dates  were  mingled  together,  and  the  national  vanity  grati- 
fied itself  in  giving  Greek  origin  to  both,  and  in  transferring  the  thea- 
ter of  all  the  celebrated  events,  and  great  discoveries,  to  the  hellenic 
territory.  The  earliest  chroniclers  appearing  a  long  time  afterward, 
made  no  efibrt  to  go  back  to  the  source  of  the  traditions,  and  clear  up 
their  obscurity,  by  comparing  them  with  each  other ;  they  only  made 
themselves  the  echoes  of  popular  belief.  This  is  the  reason  why  the 
mythology  of  the  Greeks,  although  sufficiently  modern,  offers  as  much 
uncertainty  and  obscurity  as  that  of  nations  much  more  ancient. 


THE   ORIGIN   OF   MEDICmE.  53 


CHAPTEE    II. 

MEDICINES  OF  SOME  OTHER  NATIONS  OF  THE  OLD  AND  NEW  WORLD. 

The  history  of  other  nations  offers  nothing  peculiarly  remarkable, 
in  a  medical  point  of  view.  All  that  can  be  affirmed  of  each  one  of 
them  is,  that  just  as  far  as  we  can  go  back  in  their  annals,  we  always 
find  some  vestiges  of  Medicine.  Thus,  Hippocrates  mentions  certain 
medical  practices,  in  use  among  the  Scythians.  We  have  stated  before 
the  practice  of  the  Porkiguese  and  Babylonians,  of  exposing  the  sick 
before  the  doors  of  the  houses,  in  order  that  passers-by  might  give 
them  their  advice.  In  short,  we  also  know,  that  in  Gaul  and  in  the 
Britannic  isles,  the  Druids  were  at  the  same  time  priests,  legislators  and 
physicians,  and  that  their  women  shared  with  them  their  offices  and 
prerogatives. 

In  the  New  World,  the  same  phenomena  are  produced  among  a  people, 
who  have  bad  no  species  of  communication  with  the  inhabitants  of  the 
Old  World.  Antonio  de  Solis  states,  that  Montezuma,  emperor  of 
Mexico,  possessed  gardens,  where  great  numbers  of  plants  were  culti- 
vated, whose  properties  were  well-known  to  the  physicians  of  the 
country,  who  employed  them  with  success.  Cortez  having  been  attacked 
with  a  grave  disease,  assembled  a  council  of  the  most  skillful  native 
physicians,  who  employed  various  remedies,  and  in  a  short  time  restored 
the  eminent  patient  tg  health.  In  the  island  of  St.  Domingo,  the 
priests  named  butios,  were  both  physicians  and  apothecaries.  Among 
the  Apalachicolas,  a  tribe  in  Florida,  the  sacrificers  to  the  sun,  practiced 
Medicine,  to  the  exclusion  of  other  castes.  Finally,  now  that  all  parts 
of  the  globe  have  been  explored,  we  are  able  to  repeat  with  assurance, 
that  sentence  of  the  elder  Pliny,  which  says,  "  no  nation  has  existed, 
entirely  destitute  of  Medicine,  though  some  may  be  found,  that  have 
had  no  men,  especially  occupied  as  physicians." 


CHAPTEE    III. 
THE    ORIGIN   OF   MEDICINE. 


If  we  should  be  asked,  what  has  taught  men  to  provide  themselves 
with  things  indispensable  to  life ;  to  prepare  their  food  and  clothing, 
and  habitations  against  the  inclemencies  of  the  seasons,  etc.;  our  unem- 
barrassed and  prompt  reply  would  be :  it  is  necessity,  it  is  the  instinct 


54  PRIMITIVE   PERIOD. 

of  preservation.  Again,  if  we  are  asked,  what  has  inspired  the  same 
men  to  aversion  for  pain,  the  fear  of  disease  and  death,  the  desire  to 
prevent  sickness,  not  only  for  themselves,  but  also  for  all  those  that  are 
dear  to  them ;  we  should  again  promptly  and  readily  answer,  it  is  a 
natural,  irresistible  instinct,  which  is  realized  by  the  savage  of  the  wilder- 
ness, as  well  as  by  the  inhabitants  of  cities ;  by  the  poor,  as  well  as  by 
the  rich — by  the  philosopher  and  ignorant ;  in  the  frozen  regions  of  the 
north,  as  well  as  under  the  burning  heats  of  the  tropics.  There  is  but 
one  step  between  this  instinct  and  the  invention  of  Medicine ;  and  we  shall 
proceed  to  see  how  this  has  been  achieved.  This  will  be  comparative- 
ly an  easy  task,  as  we  possess  one  of  the  most  ancient  books,  which 
furnishes  on  this  subject,  very  positive  and  explicit  testimony;  it  will 
be  sufficient  to  make  a  textual  extract. 

"Necessity  itself,"  says  the  author,  "forced  men  to  seek  the  inven- 
tion of  the  Medical  Art,  for  they  saw  as  well  as  we  do  now,  that  the 
regimen  proper  in  health,  is  injurious  in  sickness.  Moreover,  in  going 
back  into  past  ages,  I  think  that  the  kind  of  life  and  nutrition  in  vogue 
now-a-days,  would  not  have  been  discovered,  if  man,  for  his  drink  and 
food,  could  have  employed  that  which  is  used  by  the  ox,  the  horse,  and 
all  other  animals  of  an  inferior  order,  namely,  the  simple  productions 
of  the  earth,  fruits,  herbs  and  grass.  Animals  are  nourished  by  these, 
and  grow  and  live  without  any  inconvenience.  Doubtless  in  the  earliest 
times,  man  had  no  other  nourishment,  and  that  which  he  employs  at 
present,  seems  to  be  an  invention  that  has  been  elaborated  during  a  long 
course  of  years ;  for  rude  and  coarse  diet  must  have  caused  much 
violent  suifering,  just  as  is  realized  now,  from  a  similar  alimentation. 
Those  who  make  use  of  such  crude  and  undigestible  materials  for  food, 
are  subject  to  pains,  diseases  and  sudden  death.  But  the  people  of 
those  times,  being  habituated  to  it,  doubtless  suffered  less  than  we  suflFer  ; 
nevertheless,  the  evil  was  great,  even  for  them ;  and  many,  especially 
those  of  a  feeble  constitution,  must  have  perished.  Such,  it  seems  to 
me,  was  the  cause  of  men  seeking  food,  more  in  harmony  with  our 
nature ;  which  led  to  the  discovery  of  that  which  is  now  employed. 

"  The  men  who  sought  and  discovered  the  Art  of  Medicine,  having  the 
same  ideas  as  those  of  whom  I  have  spoken  above,  did  I  presume,  when 
not  feeling  well,  withdraw  something  from  their  accustomed  food;  and 
in  place  of  a  full  diet,  dii-ccted  the  sick  to  eat  less.  It  happened  that 
this  regimen  was  sufficient  to  arrest  diseases  in  some  persons,  not  in  all, 
however ;  for  some  of  them,  were  in  such  a  state,  that  they  could  not  be 
relieved,  even  by  the  use  of  a  smaller  quantity  of  their  usual  food. 
Then  it  was  suggested  to  prescribe  a  weaker  diet,  and  soup  was  invented, 
in  which  a  small  quantity  of  solid  substance,  is  mingled  with  much 


UTILITY  OF  MEDICINE.  55 

water,  and  ■well  diffused  by  boiling.  Finally,  those  ■who  could  not  even 
support  soup,  were  supplied  with  simple  drinks ;  care  being  taken  to 
give  them  neither  too  much  nor  too  little. 

"  Did  not  he  then,  who  in  the  opinion  of  all  was  called  a  physician, 
who  discovered  the  dietary  of  the  sick,  follow  precisely  the  same  course, 
as  he  who  changed  the  savage  and  brutal  manner  of  living  of  the  earli- 
est men,  by  substituting  a  diet  more  like  ours  ?  In  my  opinion  their 
method  was  the  same  and  the  discoveries  identical."-' 

This  explanation,  of  remarkable  simplicity  and  exactness,  shows  us 
how  men  were  gradually  led  to  lay  the  foundations  of  Medicine.  It 
sufficed  them  to  observe  that  certain  things  were  good,  and  others  bad, 
so  that  the  former  might  be  employed,  but  the  latter  abstained  from. 
Thus,  as  the  application  of  a  hot  cataplasm  on  the  side  soothes  the 
pain  of  pleurodynia,  in  Thrasimenus;  it  was  naturally  supposed  that 
the  same  remedy  would  relieve  Eurimedon  of  a  similar  trouble; 
so  a  venesection,  having  cured  the  daughter  of  Damatia,  deprived  of 
consciousness  by  a  fall  from  the  roof,  it  was  concluded  that  all  simi- 
lar cases  should  be  treated  in  a  like  manner.  The  reasoning 
under  these  circumstances  was  very  simple ;  no  inquiry  was  made  as  to 
the  mode  of  cure  by  the  remedy,  it  was  sufficient  to  show  that  they 
were  cured,  in  order  to  feel  authorized  to  apply  the  same  treatment  to 
analogous  cases.  Observation  and  memory  then,  which  constitute  ex- 
perience, were  the  principal  faculties  put  in  exercise ;  reason  entered  very 
little  into  their  therapeutical  considerations.  Such  was  the  first  step  of 
the  human  mind,  in  the  Medical  career;  it  consisted  in  substituting 
the  lights  of  experience  for  the  brute  suggestions  of  instinct,  a  substitu- 
tion rational  and  advantageous,  as  we  shall  demonstrate  hereafter. 


C  H  A  P  T  E  E    IV. 

THE  UTILITY  OF  MEDICINE  DURING  THE  PRIMITIVE  PERIOD. 

Those  who  boast  of  the  certainty  and  perspicacity  of  instinct — those 
who  wish  that  man,  in  imitation  of  animals,  followed  only  his  appetites 
in  health  and  disease ;  have  never  reflected  on  the  daily  and  often  fatal 
errors  of  the  appetites  uncontrolled.  It  will  suffice  to  give  them  some 
examples  to  unprejudice  their  minds,  and  convince  the  reader,  that  the 
lights  of  experience  aye  less  faulty  than  our  instinctive  tastes,  especially 
among  the  sick. 

=  Works  of  Hippocrates,  translation  by  M.  Littre.  Traite  de  PAncienne 
Medecine. 


56  PRIMITIVE   PERIOD. 

1.  Let  a  traveler,  after  a  long  walk  under  an  ardent  sun,  covered 
with  dust  and  sweat,  and  dying  of  thirst,  come  to  the  side  of  a  cool  and 
limpid  spring;  instinct  would  lead  him  to  take  long,  deep  draughts  of  its 
waters;  but  woe  to  him  if  he  does  not  resist  the  temptation.  It  is  not 
necessary  in  this  place,  to  recall  the  example  of  Alexander  the  Great, 
arrested  in  the  midst  of  his  triumphant  career,  for  having  yielded  to  a 
similar  temptation,  to  bathe  in  the  waves  of  the  Cydnus.  No  one 
reaches  the  years  of  discretion,  without  knowing,  either  by  personal 
experience,  or  the  hearsay  of  others,  how  dangerous  such  conduct  is, 
and  how  fatal  it  has  been  in  many  instances, 

2.  A  miserable  shipwrecked  sailor,  who  has  endured  the  torment  of 
hunger  for  many  days,  is  finally  rescued  by  a  vessel  fully  provisioned. 
Do  you  suppose  that  the  commander  of  that  ship,  would  allow  him  to 
eat  and  drink  to  full  satisfaction  ?  No,  certainly,  for  it  would  cause 
the  speedy  death  of  the  unfortunate  sufferer ;  the  blind  and  imperious 
cravings  of  his  appetite,  would  permit  only  a  partial  gratification. 

3.  A  woman  in  labor,  is  attacked  either  with  hemorrhage,  or  convul- 
sions, or  her  child  has  a  bad  presentation.  Would  you  abandon  this 
accouchement  entirely  to  the  resources  of  nature  ?  There  is  much  reason 
to  fear,  that  under  such  circumstances,  the  mother  or  the  child,  or  even 
both  would  succumb,  if  Art  comes  not  to  their  relief;  but  by  a  simple 
and  painless  maneuver,  the  skillful  accoucheur  will,  in  most  cases,  save 
the  lives  of  both. 

4.  Let  an  individual  be  attacked  with  an  intermittent  fever ;  instinct 
suggests  to  him  to  employ  much  covering,  during  the  cold  stage,  and 
cast  it  off  during  the  fever ;  and  quench  his  burning  thirst  with  copious 
draughts  of  water:  The  paroxysm  passed,  he  resumes  his  ordinary 
life  without  any  precaution,  because  he  is  sensible  of  no  change  in  his 
condition,  except  a  slight  diminution  of  strength  and  appetite.  Du- 
ring each  paroxysm,  his  instinct  suggests  only  a  repetition  of  the  same 
acts.    Now  what  will  be  the  result? 

If  the  attack  is  mild,  the  climate  healthy,  and  the  patient  have  a 
<^ood  constitution,  he  will  recover  by  the  efforts  of  nature  alone,  after  a 
few  repetitions  of  the  paroxysm ;  but  in  most  cases,  one  or  more  of  these 
favorable  conditions  are  wanting,  then  the  scene  is  changed,  and  the 
results  are  very  different.  Sometimes  the  subject  succumbs  in  a  few 
days ;  at  others,  the  fever  assumes  a  remitting  type,  and  goes  on  indefi- 
nitely, producing  at  length,  visceral  congestions,  chronic  inflamma- 
tions, and  incurable  degeneration  of  organs ;  in  fine,  in  cases  less 
severe,  the  subject  has  a  slow  convalescence,  and  is  for  a  long  time, 
incapable  of  active  labor.     Thanks  to  the  progress  of  science,  these 


I 


UTILITY   OF   MEDICINE.  57 

sort  of  affections,  formerly  so  common  and  disastrous,  are  now  rarer, 
and  much  less  formidable. 

5.  A  man  has  a  luxation  of  his  arm,  or  a  fracture  of  his  leg ;  what 
does  his  instinct  counsel  ?  To  keep  it  in  such  repose,  as  prevents  any 
movement  of  the  injured  member,  because  the  slightest  motion 
excites  severe  pain ;  but  experience  teaches  us,  that  unless  he  will  sub- 
mit to  the  momentary  increase  of  pain,  which  the  manipulations  of  his 
surgeon  will  cause  in  his  efforts  to  adjust  it,  he  will  infallibly  lose  the 
use  of  his  member,  and  very  probably  too,  endure  a  great  amount  of 
subsequent  suffering. 

In  a  multitude  of  cases  more,  it  could  be  shown  that  the  suggestions 
of  instinct  arc  faulty  and  pernicious.  After  having  proved  a  thousand 
times  the  danger  of  following  so  untrue  a  guide,  a  surer  method  was 
sought  in  the  lessons  of  experience. 

The  first  discoveries  that  were  made  on  this  plan,  appeared  so  admi- 
rable and  useful,  that  they  were  conceived  to  be  a  divine  inspiration, 
and  those  who  were  regarded  as  the  inventors  and  propagators,  received 
divine  honors.  Thus  we  see,  there  was  a  real  progress,  an  efficient 
amelioration,  by  adding  the  lights  of  experience  to  the  brute  sugges- 
tions of  instinct — in  passing  from  the  state  of  simple  nature,  to 
that  of  the  commencement  of  medical  science.  It  belonged  to  history 
and  medical  philosophy  to  establish  this  fact,  which  sanctions  and  jus- 
tifies these  early  efforts  of  the  race,  to  lay  the  foundation  of  the  Healing 
Art.  Thus  a  serious  examination,  refutes  the  eloquent  declamations 
of  those  philosophers  who  propose  to  us,  to  make  the  animals  our  models ; 
proclaiming  continually  the  unfailing  sagacity  of  instinct ;  and  so,  also, 
is  swept  away  the  apparent  wisdom  of  the  following  words  «f  J.  J. 
Rousseau,  put  in  the  mouth  of  his  pupil ;  "If  I  become  sick,"  says  Emi- 
lius,  in  a  letter  to  Sophia,  "  a  very  rare  circumstance  in  a  man  of  my 
temperament,  who  indulges  in  no  excess  of  food  or  care,  or  labor  or  rest, 
do  not  torment  me  with  efforts  to  cure  me,  nor  frighten  me  to  death. 
The  young  animal  that  is  sick,  rests  in  one  place,  gets  well,  or  dies: 
[  would  do  likewise,  and  I  should  be  the  better  by  it."" 

The  grave  philosopher  of  Geneva  had  never  reflected,  it  is  reasonable 
to  suppose,  on  the  serious  inconveniences  of  that  method,  in  an  infinite 
number  of  cases ;  among  those  cited  above,  there  are  several  in  which  it 
would  have  been  fatal. 

To  his  authority,  we  are  able  to  oppose  that  of  another  philosopher, 
who  was  his  cotemporary,  and  no  less  celebrated  than  himself.  "It  is 
admitted,"  says  Voltaire,  "that  a  good  physician  may  save  our  lives  in  a 


"  Traito  de  I'Education.     2de  Lettre  d'Emile  a  Sophie. 
4 


58  PRIMARY  PERIOD. 

hundred  cases,  and  restore  to  us  the  use  of  our  members.  A  man  falls 
with  apoplexy :  it  will  not  be  a  captain  of  infantry,  nor  a  counselor  of 
state  that  will  cure  him;  cataracts  form  in  my  eyes:  my  neighbor  can 
not  remove  them.  I  make  no  distinction  here  between  the  physician 
and  the  surgeon  ;  the  two  professions  have  been  inseparable  for  a  long 
time.  Men  who  would  occupy  themselves  with  studies  and  efforts  to  give 
health  to  other  men,  from  the  sole  principles  of  humanity,  should  be 
considered  far  above  the  grand  of  the  world;  they  were  kindred  to 
divinity.  To  preserve  and  repair,  is  nearly  as  admirable  as  to  create. 
The  Eoman  people  were  satisfied  to  remain  five  hundred  years  without 
physicians.  That  people  only  occupied  themselves  with  killing,  and 
made  no  efforts  to  save  life.  What  became  of  those  who  had  a  putrid 
fever,  an  anal  fistula,  a  carbuncle,  or  an  inflammation  of  the  lungs? 
They  died." 

But  the  greater  number  of  the  detractors  of  Medicine,  do  not  deny  in  an 
absolute  manner,  the  utility  of  the  Art,  in  a  thousand  instances ;  they 
do  not  contest,  for  example,  the  utility  of  certain  surgical  operations, 
nor  the  regimen  in  acute  diseases;  but  they  reject  in  general,  scien- 
tific Medicine,  Medicine  as  an  Art.  Thus  the  elder  Cato  pursued  with 
his  ordinary  obstinacy,  the  philosophers,  rhetoricians  and  physicians  of 
Greece,  whom  he  accused  of  corrupting  the  manners  of  the  Eomans,  and 
he  finally  succeeded  in  obtaining  a  decree  for  their  expulsion ;  but  not- 
withstanding all  his  efforts,  the  physicians  were  excepted  in  the  decree. 
This  same  Cato  wrote  a  work  on  domestic  and  veterinary  Medicine ;  he 
treated  the  men  of  his  household  and  his  animals  with  remedies  prepared 
by  his  own  hands,  and  report  says,  that  his  wife  fell  a  victim  to  his 
prejudices  in  Medicine.  The  encyclopedist  Pliny,  who  wrote  a  materia 
medica  entirely  drawn  from  Greek  authors,  did  not  dissimulate  any 
more,  the  sentiment  of  profound  jealousy  that  he  felt,  on  account  of 
the  superiority  of  that  nation  in  science  and  letters.  He  declaimed 
against  foreign  j^hysicians  with  a  blind  violence,  that  led  him  even  to 
proscribe  the  use  of  exotic  plants. 

At  this  point  naturally  belongs  the  relation  of  an  anecdote,  which  1 
once  heard  told  of  an  old  doctor,  which  I  will  endeavor  to  state  in  his 
own  words.  "I  was  one  day,"  says  the  worthy  practitioner,  "at  the 
house  of  one  of  my  patients,  who  had  recovered  from  a  rather  severe 
attack  of  illnesss,  when  an  inhabitant  of  the  neighborhood,  who  had 
lately  come  from  Paris,  called  to  pay  him  a  visit.  After  the  first  com- 
pliments the  conversation  fell,  as  is  usual  in  such  cases,  on  medicine  and 
physicians.    '  As  for  me,'  said  the  provincial, '  I  have  no  faith  in  Medicine ; 

''  Dictionnaire  Philosophique. 


RESUME   OF  THE  PRIMITIVE   PERIOD.  59 

I  believe  that  one  would  recover  just  as  wel5  without,  as  with  it.  But  then, 
I  have  never  had  a  serious  attack  of  sickness.'  Your  incredulity,  then. 
I  replied,  arises  from  that  condition,  and  you  will  do  well  to  maintain  ir. 
•  1  speak  only  for  myself,'  added  our  provincial,  '  for,  as  to  others,  I  am 
the  first  to  administer  remedies  to  them.  As  I  dwell  in  the  country, 
far  from  the  residence  of  all  physicians,  I  have  in  my  house  a  little 
pharmacy,  which  I  am  careful  to  keep  supplied,  and  when  one  of  my 
family  or  a  neighbor  falls  sick,  I  always  give  them  the  first  aid ;  and  often 
I  effect  a  cure,  before  the  arrival  of  the  doctor.'  But  then,  said  I. 
you  do  prepare  some  medicines,  and  probably  have  some  little  faith  in 
them.  '  Oh,  doubtless,  said  the  countryman,  I  have  faith  in  my  medi- 
cines, because  they  are  so  very  simple  and  natural,  as  I  employ  neither 
strong  remedies  nor  instruments.'  " 

What  difference  then  is  there,  between  the  practice  of  Cato,  the 
censor ;  of  Pliny  the  naturalist ;  of  our  rustic  citizen,  and  that  of  the 
physicians  of  their  times ;  or  to  speak  more  generally,  what  difference  is 
there  between  the  practice  of  laymen,  and  that  of  men  of  science '?  This 
only :  the  former  are  ignorant  and  timid;  the  latter  are  relatively  more 
enlightened,  firmer,  and  consequently  more  efiicacious. 

There  is  another  class  of  unbelievers  in  Medicine  whom  we  should 
pity  more  than  blame ;  I  mean  those  persons  who  are  suffering  from  in- 
curable diseases,  and  have  exhausted  all  the  resources  of  cotemporaneous 
science,  without  obtaining  any  notable  advantage.  Such  was  the  case 
with  our  skeptic  Montaigne,  who,  afflicted  with  a  urinary  calculus,  at 
an  epoch,  when  surgery,  impotent  by  ignorance,  dared  not  attempt  the 
operation  of  Lithotomy,  gave  vent  to  his  spite  in  epigrams  against  the  Art. 
Alas,  whatever  may  be  done,  whatever  perfection  this  Art  may  attain,  there 
are,  and  there  always  will  be,  cases  in  which  its  aid  will  be  inefficacious, 
and  then  the  patient  who  demands  of  us  relief  for  his  suffering,  who 
asks  of  us  life,  however  inexorable  may  be  the  law  which  condemns  him 
to  suffer  and  to  die,  seeing  the  impossibility  of  our  aiding  him,  will 
accuse  us  of  this  inevitable  result ;  and  will  declaim  against  us,  unless 
he  be  endowed  with  a  lofty  philosophy,  or  profound  resignation. 

RESUME    OF    THE    PRIMITIVE    PERIOD. 

We  have  seen  that  the  first  notions  of  Medicine  go  back  to  the 
earliest  infancy  of  society,  in  all  the  countries  of  the  world ;  so  that  we 
may  repeat  the  statement  of  Pliny,  that  if  there  exists  any  nation 
which,  at  any  epoch  of  its  history,  was  without  physicians,  there  is  not  one 
in  which  we  do  not  find  some  vestiges  of  Medicine.  W^e  conclude  from 
this,  in  opposition  to  Plato,  and  some  other  philosophers,  that  the  first 


60  PRIMITIVE  PERIOD. 

elements  of  the  Healing  Art  are  not  at  all  the  result  of  the  degenera- 
tion of  human  nature,  brought  about  by  softness  and  luxury ;  but  that 
they  spring  from  that  natural  instinct,  which  makes  a  man  fly  from 
danger  and  death,  and  sympathize  with  the  aflSictions  of  his  fellows. 
We  have,  therefore,  endeavored  to  penetrate  further  than  has  been 
done,  up  to  this  time,  into  the  workings  of  the  human  mind,  by  which 
the  first  materials  of  medical  science  were  developed,  and  we  have 
found  that  this  process  consists,  principally,  in  the  addition  of  the 
lights  of  experience  to  the  brute  impulses  of  instinct.  In  fine,  having 
sought  to  appreciate  the  results  of  that  antique  revolution,  we  have 
established,  by  a  severe  analysis,  that  the  results  have  been  advan- 
tageous to  humanity.  We  now  proceed  to  follow  science  through  a  new 
phase ;  we  shall  behold  it  expand,  from  its  beginning,  by  successive 
development,  as  a  river  swells  and  grows  broader  from  its  origin,  by  the 
tribute  of  its  branches.  We  shall  have  to  notice  more  than  once,  the 
errors  and  abuses  which  have  disturbed,  diverted,  and  sometimes  turned 
it  backward  in  its  course ;  but  let  come  what  will,  in  the  labyrinth  of 
contradictory  opinions  into  which  we  must  plunge,  we  shall  take  for  our 
motto,  that  of  the  Deontologie  Medicale,  of  Dr.  Max.  Simon:  "  Truth 
in   Science,  and  Morality  in  Art.^^'-' 

*  See  the  dedication  of  that  work. 


GENERAL  CONSIDERATIONS.  61 


II.   MYSTICAL   PERIOD. 

COMPRISING  A  SPACE  OF  TIME  EXTENDING  FROM  THE  TROJAN   WAR.  B.  C.  IISI. 
TO  THE  DISSOLUTION  OF  THE  PYTHAGOREAN  SOCIETY,  B.  C.  500. 


GENERAL     CONSIDERATIONS. 

The  Trojan  war,  celebrated  in  the  Songs  of  Homer,  appears  in  Greek 
antiquity  as  a  luminous  point  in  the  midst  of  profound  darkness. 
Before  this  memorable  expedition,  and  for  a  long  time  afterward,  the 
history  of  Medicine  rests  on  uncertain  traditions,  often  mino-led  with 
fables.  The  hellenic  nation,  which  was  one  day  to  become  the  instruc- 
tress of  the  human  race,  had  not  yet  shaken  off  the  rust  of  barbarism. 
Egj'pt,  Phenicia,  and  Chaldea,  marched  at  the  head  of  civilized  nations. 

But  after  the  Grecian  chiefs  had  overturned  the  throne  of  Priam,  and 
destroyed  his  capital,  the  freedom  of  the  seas  was  attained.  Their  ves- 
sels could  cruise,  unmolested,  from  Palus-Mceotidus  to  the  Straits  of 
Gibraltar.  After  that  event,  the  Hellenists  covered,  with  their  colonies, 
the  coasts  of  Asia-Minor,  the  isles  of  the  Archipelago,  and  the  south  of 
Italy.  They  sent  emigrants  as  far  as  Gallia,  Spain,  and  the  shores  of 
Africa.  Their  navigators  dared  even  to  pass  the  pillars  of  Hercules, 
and  adventure  upon  the  ocean. 

It  was  not  solely  the  desire  of  riches  and  power,  that  caused  them  to 
undertake  long  peregrinations ;  a  more  noble  sentiment,  the  love  of  wis- 
dom, or  of  science,  animated  some  of  these  travelers.  They  are  seen 
renouncing  their  families  and  friends  for  a  great  number  of  years,  and 
returning  afterward  to  share  freely  with  their  fellow-citizens  the  trea- 
sures of  light  they  had  amassed  in  foreign  lands.  Thus,  a  Lycurgus 
and  a  Solon  were  worthy  to  give  laws  to  their  country,  and  place  in  the 
constitutions,  which  are  still  admired,  the  foundation  of  the  grandeur  of 
Sparta  and  Athens.  So  a  Thales,  a  Pythagoras,  and  a  Democritus,  be- 
came the  chiefs  of  schools,  or  of  sects,  which  shed  upon  their  names  so 
much  glory. 

Nevertheless,  science  and  letters  had  advanced  but  very  slowly,  in 
Greece,  during  the  space  of  seven  hundred  years,  which  separates  the 
Trojan  war  from  the  dispersion  of  the  Pythagoreans.     A  very  small 


62  MYSTICAL  PERIOD. 

number  of  men  devoted  themselves  to  the  study  of  the  liberal  arts,  and. 
with  the  exception  of  the  poems  of  Hesiod  and  Homer,  there  remains  to 
us  no  literary  monument  of  that  long  period.  Medicine  shared  the  fate 
of  the  other  sciences ;  buried  in  the  depths  of  the  temples  of  Escula- 
pius,  it  made  an  unseen  progress,  which  it  is  impossible  for  the  historian 
to  trace. 


CHAPTER    I. 
THE  PRACTICE  OF  MEDICINE  IN  THE  TEMPLES. 

Fifty  years  after  the  destruction  of  the  kingdom  of  Priam,  there  was 
elevated  at  Titanus,  a  city  of  the  Peloponnesus,  the  first  temple  in  honor 
of  Esculapius.  Very  soon  the  worship  of  this  god  was  spread  through- 
out G-reece,  whence  it  passed  into  Asia,  Africa,  and  Italy.  Among  a 
multitude  of  temples  which  were  consecrated  to  him,  those  at  Epidaurus. 
in  the  Peloponnesus,  at  Pergamus,  in  Asia,  on  the  island  of  Cos,  and  at 
Cyrene,  a  city  of  Lybia,  are  particularly  remarkable. 

In  the  temple  at  Epidaurus,  there  was  a  statue  of  colossal  size,  repre- 
senting the  god  of  Medicine  under  the  figure  of  an  old  man  seated  on  a 
throne,  holding  in  one  hand  a  scepter,  and  resting  the  other  on  the  head 
of  an  enormous  serpent.  A  dog,  an  emblem  of  vigilance,  reposed  at  his 
feet.  This  statue,  made  of  gold  and  ivory,  was  the  work  of  Trasyme- 
dus.  Socrates,  in  his  last  discourse  with  his  friends,  requested  them  to 
ofier  a  cock,  as  a  sacrifice  for  him,  to  Esculapius ;  whence  we  infer  that 
this  bird  was  sacred  to  the  god  of  Medicine. '■■■' 

The  priests  attached  to  his  worship  were  named  Asclepiadge,  a  word 
which  signifies  descendants  of  Esculapias.  They  formed  a  particular 
caste,  governed  by  sacred  laws,  like  the  priests  of  Egypt.  One  of  their 
ancient  laws  said,  "  that  it  is  not  permitted  to  reveal  sacred  things, 
except  to  the  elect,  and  strangers  must  be  admitted  to  this  knowledge 
only  after  having  submitted  to  the  tests  of  initiation." 

The  temples  of  the  god  of  Medicine  were  generally  very  salubriously 
situated;  sometimes  on  the  summit  of  a  hill,  or  the  declivity  of  a 
mountain  ;  sometimes  on  the  shore,  somewhat  distant  from  the  sea,  and 
near  to  a  thermal  spring,  or  fountain  of  living  water.  Groves  of  trees 
refreshed  the  sight  of  the  sick,  and  afforded  to  them  cool  and  solitary 
retreats  in  their  beautiful  and  spacious  avenues. 

■'  Dialogues  of  Plato,  the  Phedon. 


PKACTICE  OF  MEDICINE    IN   THE  TEMPLES.  63 

The  people  came  from  all  quarters  on  pilgrimages  to  these  places,  sacred 
to  the  god  of  Medicine.  The  sick  and  the  convalescent  found  there, 
both  agreeable  and  healthful  diversions.  The  wholesome  regimen  to 
which  they  were  subjected  ;  the  pure  and  temperate  air  they  breathed  ; 
the  faith  and  hope  by  which  some  of  them  were  animated ;  the  miracu- 
lous cures  that  were  testified  to,  all  united  to  affect  their  minds  agreeably, 
and  exercise  a  happy  influence  on  their  constitution. 

Beside  these  hygienic  means,  the  AsclepiadDe  employed  special  reme- 
dies appropriate  to  each  disease,  according  to  the  notions  they  then  had 
of  it.  They  prescribed  according  to  circumstances,  venesection,  purga- 
tion, vomits,  friction,  sea-bathing  and  mineral  waters ;  in  a  word  they 
neglected  none  of  the  therapeutical  means  they  possessed  in  those  times. 

Knowing  the  gi'eat  influence  of  the  morale  on  the  physiqiie.  these 
priest-doctors  employed  every  means  to  control  the  imagination  of  their 
patients.  These  were  not  permitted  to  interrogate  the  oracle,  until  they 
were  purified  by  abstinence,  fasting,  prayers  and  sacrifices.  When  all 
these  purifications  were  accomplished,  the  consultants  were  introduced 
to  receive  the  response  of  the  oracle.  Sometimes  they  were  obliged  to 
lie  in  the  temple  for  one  or  more  nights.  Sometimes  the  god  spoke  in 
a  mysterious  manner,  without  showing  himself  to  the  eyes  of  the  faith- 
ful ;  sometimes  he  appeared  to  them  under  the  form  of  a  serpent,  de- 
vouring the  cakes  on  the  altar  ;  again,  he  manifested  his  will  in  dreams, 
which  were  interpreted  by  the  priests. 

The  patients  who  recovered,  went  to  their  homes  blessing  the  divine 
author  of  their  recovery,  and  leaving  behind  them  testimonials  of  their 
gratitude.  Those  who  received  no  beneficial  nor  favorable  response,  be- 
lieving that  their  offerings  were  rejected,  because  insufiicient,  redoubled 
their  zeal  and  their  liberality.  So  that  bad  as  well  as  good  results 
added  equally  to  the  glory  of  the  god,  and  the  profit  of  his  ministers. 

There  existed  in  the  country  about  Epidaurus,  and  in  various  other 
localities,  serpents  of  a  yellowish-brown  color,  whose  bite  was  not  ven- 
emous,  and  which  were  easily  tamed.  The  priests  employed  them  in 
those  supernatural  performances  which  filled  the  people  with  astonish- 
ment and  superstition.  Aurelius  Victor  relates,  "that  during  the  year 
350  of  the  foundation  of  Eome,  the  city  was  ravaged  by  a  terrible  pesti- 
lence :  the  Senate  sent  six  deputies  to  consult  the  oracle  of  Epidaurus. 
After  they  had  arrived  at  the  temple,  and  were  admiring  the  colossal 
statue  of  the  god,  suddenly,  an  enmorous  serpent  issued  from  beneath 
the  pedestal.  The  sight  of  it  impressed  every  miml  more  with  venera- 
tion than  terror.  He  moved  tranquilly  through  the  astonished  crowd 
and  entered  the  vase  of  the  Romans,  in  the  chamber  of  Ogulnius,  the 
chief  of  the  embassadors. 


64  MYSTICAL   PERIOD. 

"  The  sacred  reptile  was  piously  borne  away,  and  when  the  vessel  of 
the  embassadors  was  approaching  the  city  of  Eomulus.  he  sprang  into 
the  waves  and  swam  to  an  island  in  the  Tiber.  A  temple  was  immedi- 
ately erected  to  Esculapius,  on  that  spot,  and  the  pestilence  ceased." 

Many  other  grave  historians  of  antiijuity,  report  the  prodigies  effected 
by  the  intervention  of  the  god  of  Medicine.  Nevertheless,  every  one  did 
not  credit  them,  as  witness  the  testimony  of  the  valet  to  whom  Aristo- 
phanes in  one  of  his  comedies,  attributes  the  following  language:  "  The 
Priests  of  the  temple  of  Esculapius,  after  having  extinguished  all  the 
lights,  told  us  to  go  to  sleep,  adding,  that  if  any  one  should  hear  a  hiss- 
ino-.  which  indicated  the  arrival  of  the  god,  he  should  not  move  in  the 
slightest  manner.  So  we  all  laid  down  without  making  any  noise  ;  but 
T  could  not  sleep,  because  the  odor  of  an  excellent  broth,  that  an  old 
woman  held  near  me,  agreeably  excited  my  olfactories.  Desiring  most 
ardently  to  slide  along  to  it,  I  raised  my  head  very  quietly,  and  saw 
the  sacristan,  who  took  away  the  cakes  and  figs  from  off  the  sacred 
tables,  going  the  round  of  the  altars,  putting  into  his  sack  every- 
thing he  could  find.  I  believed  that  I  had  a  right  to  follow  his  example, 
so  I  raised  to  go  to  the  old  woman's  pot." 


CHATTER    II. 
OF  DREAMS. 

All  antiquity  has  had  faith  in  dreams,  prophets  and  philosophers — 
strong  and  weak  minds,  all  believed  that  the  Divinity  employed  these 
means  to  reveal  the  future  and  instruct  us  in  his  designs.  Sacred  and 
profane  history  are  full  of  examples  that  attest  the  universality  of  this 
sentiment.  It  is,  then,  more  than  probable  that  the  Asclepiadse  shared 
in  it,  and,  moreover,  as  it  was  advantageous  to  them,  they  must  have 
tried  to  maintain  this  belief,  by  pious  frauds.  Thus,  while  they  endeav- 
ored to  draw  from  dreams  some  natural  indication,  they  affected  to  con- 
sider them  also  as  a  divine  manifestation,  above  the  laws  of  nature.  In 
all  ages,  the  signs  furnished  during  the  sleep  of  the  sick,  have  been 
profitably  studied  in  a  semiotic  point  of  view ;  and  in  this  sense,  dreams 
have  an  importance,  which  was,  doubtless,  very  much  exaggerated  by  the 
ancients,  but  has  been  too  much  neglected  by  moderns. 

My  readers,  I  think,  will  not  be  displeased  to  find  here  some  extracts 
from  one  of  the  most  ancient  treatises  that  exists  on  this  subject. 


OF  DREAMS.  65 

"  Whoever,"  says  the  author  of  this  book,  "  desires  to  know  the  in- 
ferences that  may  be  drawn  from  dreams,  will  find,  in  the  first  place, 
that  they  are  closely  related  to  what  has  transpired  during  the  previous 
day.  The  soul,  during  sleep,  is  untrammeled  ;  but  while  it  is  distracted 
by  its  service  to  the  body,  its  existence  is,  as  it  were,  divided  ;  it  is  not 
entirely  itself,  but  belonging,  in  part,  to  the  bodily  wants,  it  subserves 
the  senses,  as  sight,  hearing,  touch,  and  the  faculty  of  voluntary  move- 
ments ;  it  directs  the  various  operations  of  business ;  in  short,  it  gives  aid 
to  every  act  of  the  body  requiring  thought,  which  prevents  it,  in  some 
degree,  from  enjoying  its  own  innate  reflections. 

"  When  the  body  is  asleep,  the  soul  visits  every  part  of  this  her  habita- 
tion, and  regulates  all  its  various  functions.  The  body  is  then  uncon- 
scious, but  the  soul  is  awake,  it  possesses  all  its  intelligence,  it  sees 
visible  things,  it  hears  sounds,  it  feels,  it  moves,  it  is  pained  and  irri- 
tated. In  brief,  the  soul  during  sleep,  performs  everything  that  relates 
to  the  body  and  the  soul,  and  wisdom  is  largely  possessed  by  him  who 
is  able  thus  to  comprehend  it. 

"  We  see  persons  much  occupied  with  this  art,  who  pretend  to  under- 
stand and  explain  dreams  sent  by  the  gods  to  announce  beforehand,  the 
good  and  the  evil  with  which  cities  or  persons  are  menaced.  Sometimes 
they  are  correct,  at  others  they  are  mistaken ;  but  no  one  knows  why  it 
is  so. 

"  They  say  there  is  something  to  be  done  to  guarantee  persons  or 
places  against  certain  evils,  but  not  knowing  really  what,  prayers  to  the 
gods  are  prescribed.  It  is,  doubtless,  good  to  pray  to  the  gods  ;  it  is 
always  apropos ;  but  it  is  necessary  also,  for  a  person  to  concur  with 
the  divinity,  and  endeavor  to  help  himself  while  invoking  his  aid."'-'' 

We  remark,  first,  that  the  author  of  the  passages  just  quoted  does 
not  deny  the  possibility  of  dreams  being  sent  by  the  gods,  but  he 
questions  the  art  of  those  who  pretend  to  interpret  them.  He  judiciously 
observes  that  these  persons  happen  sometimes  to  be  right,  and  at  others 
are  mistaken  ;  that  is,  that  the  event  sometimes  justifies  their  prediction,. 
and  sometimes  contradicts  it,  without  any  one  knowing  how  or  why. 

He  gives  a  theory  of  dreams,  which  he  thinks  is  perfectly  natural  and 
which  may  be  summed  up  as  follows :  the  soul,  or  the  vital  principle,  or- 
to  use  the  language  of  anatomists,  the  encephalic  organ,  being  free  from 
external  distractions  during  sleep,  perceives  much  better  the  sensa- 
tions that  proceed  from  the  viscera,  and  manifests  them  more  distinctly. 
This  is  a  theory  which  we  may  find  to  be  contrary  to  observation,  but 
which,  at  first  sight,  is  neither  absurd  nor  unreasonable. 

-  "  CEuvres  Hippocratiques,"  Gardeil,t.  Ill — Songes,  §  1. 


66  MYSTICAL   PERIOD. 

Unhappily,  the  author  of  it  does  not  exhibit  the  same  spirit  of  wis- 
dom in  the  applications  he  makes  of  it.  He  gives  as  the  true  results  of 
observations,  the  most  singular  fancies,  only  worthy  of  a  theosoph  of 
the  sixteenth  century.     I  will  cite  but  one  of  them  : 

"  When  one  sees,  in  his  dreams,  either  the  sun  or  the  moon,  or  the 
sky  with  the  pure  and  serene  stars,  it  is  a  good  sign  ;  it  indicates  the 
health  of  the  body.  Observation  has  proved  that  the  firmament  res- 
ponds to  the  surface  of  the  body  ;  the  sun  to  the  muscles,  and  the  moon 
to  the  cavities  that  contain  the  viscera.  When  in  the  dreams,  one  of 
these  stars  appears  to  be  changed  or  is  obscured,  or  arrested  in  its  course, 
the  seat  of  the  malady  is  its  corresponding  part  in  the  body.  If  there 
appears  any  disorder  in  the  sky,  occasioned  by  the  air  or  the  clouds, 
the  evil  is  less  than  if  produced  by  rain  or  hail ;  it  indicates  a  separa- 
tion of  watery  humors  and  phlegm,  which  are  carried  to  the  skin.  In 
this  case  it  is  necessary  to  take  exercise  by  running,  being  clothed  ;  com- 
mencing gently,  then  quicker,  so  as  to  sweat  freely.  On  leaving  the 
gymnasium,  long  walks  should  be  taken,  while  fasting.  For  five  days, 
one-third  of  the  food  should  be  left  off  to  be  gradually  assumed  again. 
If  the  above  sign  was  very  strong,  a  vapor-bath  should  be  used,  as  it  is 
necessary  then  to  deplete  the  skin,  because  the  disease  is  in  the  peri-" 
phery  of  the  body.  Dry  food  should  be  used,  with  bitters,  astringents 
and  spices,  and  such  exercise  be  taken  as  will  produce  free  perspira- 
tion." •■- 

The  treatise  from  which  I  have  drawn  these  fragments  belongs  to 
the  historic  period  that  follows  this  ;  but  I  have  inserted  them  in  this 
■  chapter  to  complete  what  I  have  to  say  concerning  dreams,  for  I  shall 
have  no  other  occasion  to  recur  to  this  matter  ;  the  great  physicians  of 
following  ages  having  occupied  themselves  with  other  objects  which  they 
judged  better  calculated  to  improve  the  diagnosis  of  diseases. 


CHAPTER    III. 

MEDICAL  TEACHING  IN  THE  TEMPLES. 

The  priests  of  Esculapius  formed,  as  we  have  before  said,  a  separate 
■caste,  transmitting  from  one  to  another  their  medical  knowledge  as  a 
family  heritage.  In  the  remotest  times,  no  layman,  according  to  the 
report  of  Galen,  was  admitted  to  participate  in  the  sacred  science,  but 

'5 "  (Euvres  Hippocratiques,"  Gardeil,  t.  Ill— Songes,  §  111. 


MEDICAL  TEACHING   IN  THE   TEMPLE.  67 

at  a  later  period,  this  severe  secrecy  was  relaxed.  Tliey  consented  to 
reveal  their  secrets  to  strangers,  provided  they  would  fulfill  the  tests  of 
initiation.  There  was,  then,  according  to  every  probability,  some  sort 
of  iledical  instruction  given  in  each  temple.  Indeed,  history  has  pre- 
served the  memory  of  three  schools  that  had  a  great  reputation,  viz : 
that  of  Ehodes,  the  most  ancient  of  all,  which  had  already  ceased  to 
exist,  at  the  time  of  Hippocrates,  and  of  whose  doctrines  we  have  no 
accounts  whatever ;  that  of  Cnidus,  which  was  the  first  to  publish  a 
small  repertory,  with  the  title  of  the  Cnidian  Sentences  ;  finally,  that  of 
Cos,  the  most  celebrated  of  all,  and  which  has  given  birth  to  a  great 
number  of  illustrious  physicians,  whose  writings  constitute  the  most 
valuable  memorials  of  antique  j\Iedicine.  Among  the  means  of  instruc- 
tion offered  by  the  priests  of  Esculapius,  there  is  one  that  deserves  to 
arrest  us  for  a  moment,  because  it  is  specially  relative  to  the  historic 
period  with  which  we  are  now  occupied ;  I  mean,  the  votive  tablets 
which  it  was  customary  to  faster  to  the  walls  and  columns  of  the  temples 
after  the  example  of  the  Egyptians.  These  tablets  showed,  generally, 
the  name  of  the  patient,  the  kind  of  disease  with  which  he  was  attacked, 
and  the  manner  of  his  cure. 

One  of  these  tablets,  found  at  Eome,  on  the  island  in  the  Tiber,  the 
site  of  the  ancient  Esculapian  temple,  bears  the  following  inscription, 
in  Greek  characters : 

"  Lately  a  certain  Caius,  who  was  blind,  came  to  consult  the  oracle. 
The  god  required  that  he  approach  the  sacred  altar  to  perform  adora- 
tions ;  at  once  he  passed  from  the  right  to  the  left,  and  having  rested 
his  fingers  on  the  altar,  he  raised  his  hands  and  applied  them  to  his 
eyes.  He  recovered  his  sight  immediately,  in  the  presence  of  the  people, 
who  rejoiced  to  see  such  marvels  accomplished  under  the  reign  of  our 
august  Antonius." 

"  Lucius  was  attacked  with  a  pleurisy,  and  every  one  despaired  of  his 
life.  The  god  ordered  that  the  ashes  of  the  altar  be  taken,  mingled 
with  wine  and  applied  to  his  side.  He  was  saved,  and  gave  thanks  to 
god  before  the  people,  who  congratulated  him," 

"  Julian  vomited  blood,  and  appeared  lost  beyond  recovery.  The 
oracle  ordered  him  to  take  the  pine  seeds  of  the  altar  and  eat  them  for 
three  days,  mingled  with  honey.  He  did  so,  and  was  cured.  Having 
solemnly  thanked  god,  he  went  away." 

"  The  god  gave  this  direction  to  a  blind  soldier  named  Valerius  Aper : 
Take  the  blood  of  a  white  cock,  mingle  it  with  honey,  and  make  a  col- 
lyrium,  which  you  are  to  apply  to  the  eyes  for  three  days.  The  soldier 
having  fulfilled  the  direction  of  the  oracle,  was  restored  to  sight,  and 
returned  to  make'  a  public  thanksgiving  to  God." 


68  MYSTICAL  PERIOD. 

Narratives  of  this  kind,  and  written  in  such  style,  were  well  calcu- 
lated to  fortify  the  piety  of  the  faithful ;  but  certainly,  they  do  not  serve 
any  great  end  for  the  advancement  of  science.  The  writers  who  have 
boasted  of  this  method  of  instruction,  have  not  reflected,  apparently, 
upon  its  glaring  defects.  Of  what  advantage,  for  example,  is  the  record 
of  the  third  case — "  Julian  vomited  blood,  and  appeared  to  be  beyond 
recovery  ?"  What  physician  would  dare  rest  a  prognosis  or  direct  a 
treatment  on  so  vague  an  indication  ?  Can  we  treat  indifferently,  in 
the  same  manner,  a  stout  man,  or  an  infant,  or  an  old  man — a  plethoric 
or  an  anaemic  patient — a  hemoptysis,  or  a  hematemesis,  or  a  scorbutic 
hemorrhage  of  the  buccal  mucous  membrane  ?  •■■= 

It  requires  no  reflection  to  say  that  a  disease  cannot  be  announced 
by  one  or  two  symptoms;  but  rather  it  is  necessary  to  recall,  1st,  all 
the  anterior  circumstances  which  could  have  contributed,  directly  or  in- 
directly, to  promote  it ;  2d,  to  ascertain  the  age,  sex,  temperament,  and 
usual  habits  of  the  patient ;  3d,  finally,  to  describe  with  the  greatest 
care  the  actual  general  state  of  the  patient,  and  make  every  possible 
effort  to  know  the  organ  principally  affected,  as  well  as  the  nature  of 
the  lesion  of  which  it  is  suffering. 

It  is  presumable  that  the  Asclepiadse  wrote  down  in  secret  the  his- 
tory of  each  disease,  and  the  means  employed  to  combat  it ;  but  we  are 
ignorant  through  how  many  degrees  science  passed  before  it  attained 
the  stage  of  development  exhibited  in  the  Hippocratic  works.  But  we 
may,  at  all  events,  judge  from  the  exquisite  taste  and  precision  which 
characterize  some  of  these  books,  that  they  had  for  a  long  time  been  in 
the  habit  of  closely  observing  and  clearly  describing  diseases. 


CHAPTEE    IV. 

THE  ORIGIN  OF  CLASSIFICATIONS  IN  PATHOLOGY. 

WuEN  a  great  number  of  pathological  descriptions,  sufliciently  detailed, 
were  collected,  the  embarrassment  of  such  an  accumulation  began  to  be 
realized.  Indeed,  how  could  such  a  mass  of  material,  arranged  with- 
out any  order,  be  made  serviceable '?     How  find  in  this  pell-mell  the 

"'"I  have  seen  a  -woman  attacked  with  a  hemorrhage  of  this  nature  who  threw 
oflf  mouthfuls  of  blood:  she  had  already  filled  several  basins.  The  liquid  was 
seen  running  from  the  surface  of  all  the  gums.  This  fearful  affection  brought 
the  patient  within  two  fingers'  length  of  the  grave,  and  only  yielded,  at  last,  to 
reiterated  cauterization  with  the  nitrate  of  silver." 


ORIGIN   OF  CLASSIFICATIONS.  69 

record  they  wished  to  consult — the  tableau  which  answered  best  the 
symptoms  of  the  disease  before  them  ?  Xo  man's  memory  was  equal  to 
such  a  task. 

In  proportion  as  clinical  observations  multiplied,  it  became  every  day 
more  necessary  to  arrange  them  after  a  method  which  would  impress 
them  upon  the  memory,  and  facilitate  a  recurrence  to  them  when  desi- 
rable. Such  was  the  origin  of  the  first  pathological  classification.  The 
idea  was  suggested,  as  is  seen,  by  the  necessity  of  relieving  the  memory 
and  the  desire  of  facilitating  researches.  We  are  ignorant  of  the  mode 
of  classification  first  employed.  We  only  know  that,  from  the  begiuning 
of  the  philosophic  period,  diseases  were  arranged  by  groups,  according 
to  the  locality  afi'ected,  descending  from  the  head  to  the  feet.  Fevers 
and  other  affections  that  attack  the  whole  economy,  or  a  great  number 
of  parts,  at  the  same  time,  were  arranged  in  separate  groups.  This  dis- 
position, which  is  met  with  in  the  works  of  Hippocrates,  was  adopted, 
with  improvements  and  variations,  down  to  an  epoch  not  far  from  our 
own. 

The  first  men  who  reflected  on  the  phenomena  of  nature,  in  endeavor- 
ing to  solve  their  causes,  principles,  and  ends,  did  not  imagine  anything 
better  to  explain  the  movements  of  bodies  and  their  continual  trans- 
formations, than  to  people  the  universe  with  spirits  ;  that  is,  with  invisi- 
ble and  impalpable  substances  endowed  with  force,  intelligence  and  will, 
in  different  degrees.  Each  body  was  supposed  to  contain  at  least  one  of 
these  spirits.  This  presided  over  and  gave  impulsion  to  all  the  changes 
and  anatomical  phenomena  which  occurred  in  the  body  to  which  it  was 
attached.  Man,  whose  organization  is  so  complicated  and  whose  func- 
tions are  so  numerous — whose  intelligence  is  carried  to  the  highest  ab- 
stractions, to  the  idea  of  infinity — who  is  lost  in  the  interpretation  of 
the  most  simple  phenomena,  as  the  movement  of  the  finger  or  the  form- 
ation of  an  atom  of  matter — whose  will  controls  the  surrounding  ele- 
ments, but  who  cannot  prevent  a  hair  turning  white — man,  I  repeat. 
appeared  to  the  early  sages  as  a  multiplied  being,  a  little  representation 
of  the  universe :  consequently,  his  body  was  divided  into  many  regions 
or  departments,  which  were  supposed  to  be  governed  by  spirits  of  different 
orders.  The  system  of  Pythagoras,  which  we  shall  soon  describe,  offers 
the  first  example  of  this  physiological  polygarchy :  it  is  the  source 
whence  are  derived  a  multitude  of  ancient  and  modern  theories. 


70  THERAPEUTICS. 

CHAPTER    V. 

THERAPEUTICS. 

We  liavc  heretofore  said  that  the  physicians  of  primitive  times  rea- 
soned very  little  on  morbid  phenomena,  or  the  effects  of  remedies  ;  that 
they  contented  themselves  to  observe  which  were  the  remedies  that 
would  heal  certain  diseases,  and  to  employ  thereafter  the  same  means 
in  like  cases. 

It  appears  that  during  the  mystical  period  no  other  plan  was  followed. 
Hippocrates,  Celsus,  Galen,  and  all  the  historiographers  of  Medicine, 
agree  in  saying  that  before  the  introduction  of  philosophy  into  this 
science,  i.  e.,  before  the  age  of  Pythagoras,  there  was  no  other  rule  than 
empiricism.  But  by  this,  these  authors  do  not  allude  to  rational  empiri- 
cism, which  had  its  origin  much  later,  in  the  school  at  Alexandria :  they 
speak  of  instinctive  or  natural  empiricism,  which  we  have  referred  to 
in  the  primitive  period,  and  which  is  still  daily  followed  by  persons, 
strangers  to  the  art,  when  they  obtrude  themselves  to  give  counsels  to 
the  sick.  These  persons  have  constantly  in  their  mouths  these  words : 
'  I  have  seen  a  disease  similar  to  this  cured  by  such  a  remedy."  Their 
reasoning,  however  gross  it  appears  to  us,  is  based  on  an  incontestable 
principle,  that  may  be  stated  as  follows :  Remedies  which  have  cured  a 
disease,  vmst  he  equally  efficacious  in  curing  analogous  cases. 

Nothing  is  clearer,  nothing  is  truer,  than  this  aphorism :  it  has  all 
the  infallibility  of  a  mathematical  axiom ;  and  as  the  medical  prac- 
tice of  ancient  times  rested  on  this,  an  author  that  we  have  already 
quoted  says  with  truth:  "  Medicine  for  a  long  time  has  been  in  posses- 
sion of  all  that  is  really  necessary  in  regard  to  principles  and  method. 
With  these  guides,  numerous  and  valuable  discoveries  have  been  made 
during  a  long  course  of  centuries ;  and  the  rest  will  be  discovered,  if 
capable  men,  instructed  in  the  discoveries  of  the  ancients,  shall  take 
these  for  the  point  of  departure  in  their  researches.  But  they  who 
reject  and  disdain  the  past,  and  attempt  other  methods  and  other  ways, 
pretending  to  have  found  something  new,  will  be  mistaken  and  will  mis- 
lead others."" 

Nevertheless,  complaints  are  ceaseless  of  the  uncertainty  and  insta- 
bility of  medicine.  The  science  is  accused  of  having  no  stable  princi- 
ples to  shelter  it  from  the  caprices  of  fashion  and  in  the  changes  of 

'"'ffiuvres  d'Hippocrate.     "  Traite  de  I'Ancienne  Me'decine,"  §  ii.     Translation 
.)f  M.  Littrc.    Paris,  1839. 


THERAPEUTICS.  7 1 

systems.  The  masters  of  the  art  themselves  furnish  often  the  examples 
for  this  exaggerated  declamation. 

Pinel,  frightened  by  the  difficulties  of  medical  practice,  blames 
justly  the  presumption  of  a  writer  of  the  last  century,-'  who  prom- 
ised nothing  less  than  the  solution  of  this  general  problem — "  A  disease 
being  given,  to  find  the  remedy."  But  does  he  not  himself  fall  into  a 
contrary  excess,  and  does  he  not  mistake  the  true  destination  of  Medi- 
cine, when  he  proposes  for  the  end  of  his  labors  nothing  but  the  resolu- 
tion of  the  following  question :  "  Determine  the  true  character  of  a  given 
disease,  and  its  position  in  the  nosological  scale. "f  Does  not  this 
take  from  the  medical  arch  its  most  essential  support,  its  keystone — 
therapeutics  ? 

Bichat  expresses  himself  in  these  terms,  on  the  same  subject:  "Mate- 
ria medica,  an  assemblage  of  incoherent  opinions,  is  perhaps,  of  all  the 
physiological  sciences,  that  which  most  exhibits  the  contradictions  of  the 
human  mind.  In  fact,  it  is  not  a  science  for  a  methodic  spirit ;  it  is  a 
shapeless  assemblage  of  inexact  ideas,  of  observations  often  puerile,  of 
imaginary  remedies  strangely  conceived  and  fastidiously  arranged.  It 
is  said  that  the  practice  of  Medicine  is  repulsive.  I  will  go  further : 
no  reasonable  man  can  follow  it,  if  he  studies  its  principles  as  set  forth 
in  our  materia  medicas."  | 

Broussais  is  not  less  explicit  nor  less  vehement  in  his  condemnation  of 
the  therapeutics  of  his  predecessors.  (See,  among  others,  the  xv.  chap- 
ter of  I'Examen  des  Doctrines  Medicale,  entitled,  "  De  la  Certitude  en 
Medecine." 

Complaints  so  unanimous  have  a  cause  that  it  is  the  duty  of  the  his- 
torian to  explain.  Those  who  make  them  are  not  ignorant,  certainly,  of 
the  axiom  set  forth  above,  and  which  is  in  accordance  with  common 
sense.  Thus  it  is  not,  as  think  the  vulgar,  the  absence  of  a  fundamen- 
tal principle  in  practical  ]\[edicine  which  pains  them,  but  rather  the 
difficulties,  always  great  and  sometimes  insurmountable,  that  are  met 
with  in  its  application. 

To  obtain  a  conception  of  these  difficulties,  it  will  suffice  to  glance  at 
one  of  the  most  simple  cases  in  the  practice.  Suppose,  for  example,  that 
a  case  of  palpitation  of  the  heart  is  to  be  treated.  On  this  simple  an- 
nouncement a  medicaster  or  an  apothecary  would  not  hesitate  to  pre- 
scribe digitalis,  or  thridace,  or  some  other  remedy  indicated  in  the  for- 
mulary, to  combat  this  symptom. 

*^Picairii.  f  "  Nosographie  Philos.,"  introd.,  page  iv. 

I  Bichat,  "  Anat.  Generale."     Consid.  Ge'ne'rales,  §  ii. 


72  MYSTICAL   PERIOD. 

The  true  physician,  one  who  adds  to  the  lights  of  science  a  sense  of 
duty,  would  not  be  so  prompt :  he  would,  in  the  first  place,  know  all  the 
associated  circumstances ;  then  he  would  proceed  to  examine  the  patient 
by  commencing  at  the  organ  where  the  functional  trouble  was  the  most 
apparent :  in  short,  it  would  be  only  after  having  carefully  explored  all 
the  viscera  and  all  the  functions  of  the  body,  that  he  would  feel  author^ 
ized  to  prescribe  the  treatment ;  for  he  is  aware,  that  often  the  mute 
suffering  of  an  organ  distant  from  the  heart  may  be  the  cause  of  the  pal- 
pitations, so  that  of  ten  individuals  who  complain  of  palpitation,  per- 
haps in  not  more  than  two  would  the  same  remedies  be  applicable. 
Moreover,  all  is  not  finished  when  a  practitioner  has  properly  established 
his  diagnosis.  It  is  yet  necessary  for  him  to  choose  the  remedies  proper 
to  fulfill  the  curative  indications ;  that  is,  he  must  be  well  posted  in  all 
the  internal  and  external  resources  of  therapeutics.  Finally,  it  is  neces- 
sary that  he  secure,  on  the  part  of  the  patient  and  the  attendant,  the 
faithful  execution  of  his  directions,  and  that  he  carefully  observe  their 
effects. 

If  the  enlightened  and  conscientious  practice  of  Medicine  offers  so 
much  difficulty  in  the  simpler  cases,  what  must  it  be  when  it  is  neces- 
sary to  treat  complicated  and  insidious  affections,  such  as  constitutional 
syphilis,  or  tetters,  or  scrofula,  or  leprosy,  etc.,  which,  concealed  in  the 
economy  for  months  and  years,  deepening  their  roots,  and  changing  the 
fluids,  reveal  themselves  only  in  an  ambiguous  manner,  after  having  in- 
vaded the  entire  system,  whence  it  is  almost  impossible  to  dislodge  them  ? 

But  these  cases,  embarrassing  as  they  are,  afford  the  practitioner,  at 
least,  the  opportunity  of  studying  and  reflecting  upon  them,  aiding 
himself  by  the  opinions  of  authors,  and  trying  various  means  of  cure. 
It  is  not  so,  though,  when  he  finds  himself  in  the  presence  of  the 
plague,  the  cholera,  pernicious  fevers,  and  other  epidemics,  which  fall 
like  a  tornado  upon  the  people,  carrying  off,  without  distinction,  the 
young,  the  old,  the  feeble,  and  the  robust,  overturning  at  once  all  the 
functions  of  the  organism,  assuming  the  most  varied  forms,  and  striking 
so  rapidly  that  they  allow  the  physician  neither  time  to  collect  his 
thoughts  or  to  make  experiments. 

Under  these  calamitous  circumstances,  he  has  need,  not  only  of  sci- 
ence and  discernment,  but  also  of  sang-froid,  devotion,  and  courage  to 
contest  some  victims,  at  least,  with  the  devastating  scourge.  And  at  last, 
when,  notwithstanding  so  many  causes  of  error,  he  arrives  at  the  estab- 
lishment of  an  efficacious  mode  of  treatment,  it  often  occurs  that  the 
■constitution  of  the  epidemic  is  so  modified  that  he  is  obliged  to  com- 
mence his  researches  anew. 


ORIGIN   OF   SYSTEMS.  73 

In  other  sciences,  as  physics  and  chemistry,  there  is  an  opportunity  of 
reiterating  the  same  experiment  as  often  as  necessary.  The  agents  which 
concur  to  produce  these,  are  at  our  disposal,  and  we  can  so  isolate  them 
as  to  obtain  only  their  pure  effects,  and  free  from  all  foreign  influences. 
In  practical  Medicine  it  is  entirely  different ;  here,  nature  and  accidents, 
i,  e.  diseases,  furnish  us  the  opportunities  of  experimenting ;  but,  in  the 
first  place,  the  elements  of  these  experiments  are  never  identical ;  sec- 
ondly, much  time  may  elapse  before  an  occasion  presents  itself  for 
renewing  them ;  and,  thirdly,  it  is  impossible  to  isolate  the  patients 
from  a  multitude  of  influences  that  alter  the  therapeutical  results. 
Hence  it  follows,  that  it  is  impossible  rigorously  to  infer  one  medical 
fact  from  another. 

These  views  show  why  a  long  series  of  observations,  collected  by  a  great 
number  of  observers,  at  different  epochs  and  in  different  climates,  are 
necessary  to  arrive  at  the  discovery  of  a  curative  method — to  the  acquis 
sition  of  a  therapeutical  principle.  It  is  this  which  has,  in  all  time,  dis- 
couraged great  practitioners,  and  has  driven  one  of  the  most  illustrious  of 
them  to  write  this  sentence,  in  which  he  betrays  a  profound  melancholy: 
"  Art  is  long,  life  is  short,  opportunity  fleeting,  experience  deceptive, 
and  judgment  difficult.  It  is  necessary,  not  only  that  the  physician  do 
all  he  can,  but  also  the  patient  himself,  as  well  as  his  attendants  and 
friends,  co-operate  with  him." — Hippoc.  App.  liv.  1. 

Notwithstanding  so  many  obstacles,  which  have  been  supposed  insur- 
mountable, man  has  come,  by  force  of  research,  perseverance,  and 
genius,  to  find  some  remedies  of  marvelous  efficacy  in  certain  cases,  and 
to  trace  some  rules  which  approximate  therapeutics  to  the  exact  sciences, 
as  we  shall  hereafter  show. 


CHAPTEE    VI. 

ORIGIN    OF   SYSTEMS. 

We  have  said  that  one  of  the  greatest  difficulties,  perhaps  the  great- 
est that  is  encountered  in  the  use  of  a  fundamental  axiom  in  therapeu- 
tics, comes  from  the  impossibility  of  applying,  rigorously,  a  past  fact 
in  treatment  to  a  case  in  hand ;  in  other  words,  whatever  precision  may 
be  obtained  in  diagnosis,  whatever  may  be  the  degree  of  similarity  that 
exists  between  two  pathological  states,  as  there  is  never  identity  between 
them,  it  follows,  that  a  course  of  medication  which  has  succeeded  per- 
fectly in  one  case,  may,  strictly  speaking,  fail  in  another. 
5 


74  MYSTICAL    PERIOD. 

It  is  not  less  evident,  that  the  best  means  of  avoiding,  or  rather  of 
diminishing  this  permanent  cause  of  mistakes,  consists  in  perfecting, 
more  and  more,  the  diagnosis  of  diseases,  so  as  to  give  it  the  highest 
degree  of  exactness  possible.  By  this  means,  on  the  one  hand,  the  con- 
founding of  essentially  different  morbid  states  will  be  avoided  ;  and,  on 
the  other,  the  distinction  of  others  but  slightly  differing  in  aspect,  be 
established. 

The  importance  of  diagnosis  once  recognized,  as  it  has  been  by  the 
great  physicians  of  all  ages,  there  is  no  effort  that  the  mind  has  not 
made,  no  expedients  that  have  not  been  attempted,  in  order  to  give  it  the 
highest  perfection  possible. 

The  first  plan  suggested  to  the  minds  of  observers  was,  to  take 
account  of  all  the  symptoms  that  presented  themselves  in  the  course  of 
the  disease,  and  to  record  them  in  regular  succession,  as  they  appeared. 
According  to  this  plan,  a  great  number  of  nosological  tables  were  formed, 
so  that  for  any  disease,  a  comparison  of  the  phenomena  that  appeared 
was  made  with  the  symptomatic  tables  that  had  been  framed,  and  from 
this  comparison  an  appropriate  treatment  was  deduced. 

This  method,  which  appears,  at  first  sight,  so  natural  and  exact,  is,  at 
bottom,  extremely  defective.  In  the  first  place,  it  has  the  serious  incon- 
ivenience  of  attributing  an  equal  value  to  all  the  symptoms,  while  daily 
observation  proves  that  notable  differences  exist.  In  the  second  place, 
a  long  enumeration  of  morbid  phenomena,  recorded  one  after  another, 
without  choice  or  discernment,  is  no  more  a  portrait  of  a  disease,  than 
colors,  thrown  at  hazard  upon  the  canvass,  that  of  a  person  sitting 
for  a  likeness ;  lastly,  all  classification  of  diseases  becomes  impractic- 
able on  this  plan,  for,  before  attempting  a  work  of  this  kind,  it  is  neces- 
sary to  inquire  how  many  analagous  symptoms  would  be  required  to 
place  two  affections  in  the  same  class,  and  assign  them  a  like  treatment ; 
it  would  be  absurd  to  attempt  to  answer  the  question. 

Thus  we  sec  that  there  is  no  pathological  classification  possible,  by  a 
simple  enumeration  of  symptoms,  yet,  nevertheless,  without  the  aid  of  a 
classification,  the  practice  of  Medicine  is  a  mere  groping  in  the  dark, 
and  does  not  merit  the  name  of  Art.  Without  the  advantages  of  a 
classification,  the  physician  may  justly  be  likened  to  a  blind  person 
armed  with  a  club,  and  striking  indifferently  at  the  disease  or  at  the 
patient. 

Hippocrates  strongly  felt  the  errors  of  this  manner  of  observing  and 
describing  diseases,  when  he  reproached  the  Asclepiadaj  of  Cnidus  for 
having  adopted  this  plan,  which  led  them  to  multiply,  innumerably,  the 
division  of  diseases.  "  Those  who  have  collected,"  he  says,  "  the  sen- 
tences that  are  termed  Cnidian,  have  well  traced  the  morbid  symptoms 


ORIGIN   OF   SYSTEMS.  75 

as  they  are  exhibited,  as  well  as  the  manner  in  which  certain  affections 
terminate ;  but  any  one  may  do  as  much  as  this,  without  being  a  phy- 
sician, by  asking  sick  persons  the  symptoms  they  experience.  Much 
has  been  neglected  in  the  Cnidian  sentences,  which  it  is  important  for 
the  physician  to  know,  without  questioning  the  patient,  and  which  ie 
essential  to  the  exact  appreciation  of  the  disease.  Some  were  not  igno- 
rant, however,  of  the  various  characters  of  diseases,  and  their  different 
forms,  but  erred  whenever  they  attempted  to  make  a  rational  classifica- 
tion. Such  errors  are  easily  committed,  if  distinctions  are  made  in 
diseases  from  mere  shades  of  difference,  and  if  other  names  are  given 
to  all  those  which  are  not  exactly  identical."-' 

It  is  thus  well  demonstrated  that  all  the  symptoms  of  a  pathological 
state  are  far  from  having  the  same  degree  of  importance.  This  is 
almost  a  trivial  statement  to  make  to  physicians ;  only  dull  dreamers 
and  their  stupid  adepts,  can  have  classed  together  a  frightful  headache 
and  a  simple  wrinkling  of  the  forehead,  an  intense  gastralgia  with  an 
itching  of  the  lobe  of  the  ear.  Posterity  could  not  believe  that  such 
absurdities  were  ever  perpetrated,  if  there  were  not  authentic  docu- 
ments to  attest  it.f 

From  the  moment  that  the  necessity  was  felt  of  making  a  choice 
among  morbid  phenomena,  they  have  been  divided  into  durable  and 
transient,  essential  and  accessory,  primary  and  secondary,  etc.  Then 
commenced  the  discussion  on  the  essence  of  diseases,  their  causes,  signs, 
march,  termination,  etc.  Thence,  in  short,  sprung  Medical  Philosophy, 
and  with  it,  systems  of  Medicine. 

RESUME    OF   THE    MYSTICAL    PERIOD. 

During  the  space  of  about  seven  hundred  years,  which  this  period 
embraces.  Medicine  underwent,  in  Greece,  a  first  transformation ;  from 
having  been  domestic  and  popular,  it  became  sacerdotal,  and  wrapt 
itself  in  a  mysterious  habit.  Until  that  time,  the  world  had  princes, 
captains,  shepherds  even,  acquiring  reputation  for  their  skill  in  the 
Art:  but  after  the  Trojan  war,  we  only  hear  of  consultations  given  in 
the  name  of  the  divinity,  in  the  temples,  or  in  some  celebrated  caves, 
such  as  those  of  Trophonius  and  Charonium.  Not  but  what  there 
were,  in  those  times  even,  men  also,  not  of  the  clergy,  who  assumed  to 
treat  diseases,  and  dispense  remedies  ;  but  it  appears  that  scientific 
Medicine,  if  we  may  be  allowed  so  to  call  the  limited  notions  that  were 


o  (>  Xraite  du  Regime  dans  les  Maladies  Aigue's,"  §  1,  II,  traduc.  de  Gardeil. 

t  Such,  and  even  more  silly  statements  are  found  in  Hahneman's  "Mate'ria 
Medica." 


76  MYSTICAL   PERIOD. 

in  their  possession,  was  entirely  possessed  by  the  priesthood,  and  was 
perpetuated  only  in  their  order  by  an  uninterrupted  tradition,  where  it 
slowly  developed  itself  in  the  quiet  of  seclusion. 

"The  practice  of  Medicine  in  the  temples  of  Esculapius,"  says  M. 
Aug.  Gauthier,  "  may  be  divided  into  two  epochs.  In  the  first,  which 
extends  down  to  Hippocrates,  the  Asclepiadoe,  though  employing,  for  the 
most  part,  superstitious  means,  have  rendered  service  to  science  by  the 
taste  developed  among  some  of  them  for  observation.  It  must  be  agreed, 
that  in  those  barbarous  times,  Medicine  could  make  more  progress  in 
the  hands  of  a  corporation  like  the  Asclepiadje,  than  if  it  had  been 
merely  a  domestic  or  popular  Art.  It  is  not  probable  that,  at  a  period 
80  remote,  when  the  arts  and  sciences  were  still  in  their  infancy,  a 
man  of  genius  could  be  suddenly  raised  up,  who  would  elevate  Medi- 
cine to  the  rank  of  a  science.  In  the  second  epoch,  which  extends  from 
Hippocrates  to  Christianity,  Medicine  in  the  temples  gradually  declined, 
and  was  more  frequently  a  gross  jugglery."" 

The  same  writer  adds,  a  little  further  on :  "  It  is  difficult  to  appre- 
ciate, to-day,  what  amount  of  learning  was  in  the  possession  of  the 
priests  of  the  temples,  and  what  progress  Medicine  made  in  their  hands. 
As  there  have  always  been  men  who  have  shown  a  tendency  to  admire 
what  is  ancient,  we  must  not  be  surprised  to  find  in  antiquity,  as  well 
as  in  modern  times,  writers  who  have  lauded  immeasurably  the  medical 
knowledge  of  the  Asclepiadse.  On  the  other  hand,  there  are  physicians 
who  deny  that  they  ever  possessed  any.  Thus,  M.  Malgaigne  would 
consign  the  Asclepiadae  to  that  oblivion  from  which  they  never  ought  to 
have  emerged.  He  censures  M.  Littre  for  mentioning  them,  and  pro- 
poses to  erase  their  deeds  from  the  history  of  Medicine  and  Surgery.f 
We  think  it  better  to  avoid  extravagance  on  both  sides.  It  is  probable 
that  the  reading  of  the  inscriptions  in  the  temples,  and  the  habit  of 
seeing  a  great  number  of  sick,  gave,  in  the  end,  a  certain  amount  of 
medical  instruction  to  the  priests.  "J 

This  is,  it  seems  to  me,  what  may  be  most  reasonably  said  of  that 
part  of  medical  history  so  profoundly  enveloped  in  obscurity.     Where 

■' "  Recherches  Historiques  sur  I'Exercice  de  la  Medicine  dans  les  Temples," 
etc.,  par  Auguste  Gauthier,  1844,  chap,  11. 

I  "  Lettres  sur  I'Histoire  de  la  Chirurgie,"  inserted  iu  the  Gazette  des  Hopi- 
teaux,  1842.  M.  Malgaigne  founds  his  opinion,  principally,  on  the  four  Totive 
inscriptions  heretofore  given ;  but  these  inscriptions  are  of  the  epoch  of  the 
Antonins,  and  can  not  give  us  a  correct  idea  of  those  that  were  in  the  temples  of 
the  times  of  the  ancient  Asclepiadse,  nor  especially  of  the  clinical  notes  made  by 
the  priests  themselves 

T  A.  Gauthier,  loc.  cit.  chap.  IV. 


RESUME   OF  THE   MYSTICAL   PERIOD.  77 

there  is  default  of  positive  documents,  free  course  is  unsually  given  to 
the  imagination,  and  it  is  seen  that  on  this  point,  that  of  the  erudite 
has  not  been  sterile.  But  in  the  midst  of  diverse  opinions,  which  have 
been  emitted  as  to  the  actual  knowledge  of  the  Asclepiadse,  some  of 
which  I  have  mentioned,  that  of  M.  Gauthier,  I  repeat,  appears  to  me 
the  most  reasonable,  the  best  founded,  as  well  as  most  universally 
accredited. 

Finally,  we  touch  an  epoch  in  which  the  Healing  Art  undergoes  a 
metamorphosis  far  more  interesting  for  history  and  for  philosophy,  and 
far  more  advantageous  to  humanity.  Until  this  time,  in  fact,  the 
medical  edifice  had  been  formed  of  materials  taken  at  hazard,  and 
gathered,  generally,  without  taste  or  method ;  no  harmonious  thought, 
or  premeditated  design,  directed  the  researches  of  the  men  who  made 
the  first  discoveries ;  but  afterward,  reason  and  genius  unite  to  extend 
and  improve  what  accident  and  instinct  had  suggested.  The  scientific 
monument  of  this  difficult  Art  begins  to  rise,  grand  and  majestic,  grad- 
ually harmonizing  all  its  parts.  We  shall  no  longer  follow  its  progress 
through  ages,  by  the  light  of  vague  conjecture ;  but,  with  the  help  of 
authentic  memorials,  and  debi'is  more  or  less  well  founded.  We  shall 
no  longer  be  compelled  to  divine  the  intimate  thought  of  the  laborers  in 
the  diflFerent  phases  of  its  progress,  but  we  shall  read  it,  stamped  in 
intelligible  characters  upon  the  remaining  fragments  of  their  labors. 


78  PHILOSOPHIC   PERIOD. 


III.   PHILOSOPHIC   PEKIOD. 

COMPRISING  THE  PERIOD  OF  TIME  BETWEEN  THE  DISPERSION  OF  THE  PYTHAGO- 
RIAN  SOCIETIES.  IN  THE  YEAR  B.  C.  500,  AND  THE  FOUNDATION  OF  THE  ALEX- 
ANDRIAN LIBRARY,  IN  THE  YEAR  B.  C.  320. 


GENERAL     CONSIDERATIONS. 

Until  now,  we  have  groped  our  way,  having  to  guide  us  in  the  obscu- 
rity of  remote  ages  only  feeble  lights,  scattered  here  and  there  at  long 
intervals.  But  now  we  have  reached  an  epoch,  where  science  is 
striped  of  its  mystic  vail,  and  reveals  her  secrets  in  open  day.  The 
priests  who  had  so  long  been  in  possession  of  the  doctrine  of  the  peo- 
ple, yield  now  the  grasp  of  the  scientific  scepter  to  the  philosophers : 
they  retained  only  the  exclusive  control  of  sacred  rites,  the  monopoly  of 
religious  ceremonies.  Never  was  a  happier  revolution  accomplished 
with  less  effusion  of  blood ;  the  mind  rests  with  satisfaction  on  the 
circumstances  which  prepared  and  accompanied  it. 

It  is  a  fact  worthy  of  remark,  and  which  has  not  escaped  the  atten- 
tion of  ancient  observers,  that  the  inhabitants  of  Asia,  after  having 
discovered  the  first  elements  of  the  sciences  and  the  arts,  and  after 
having  carried  them  to  a  certain  degree  of  development,  paused  in  the 
pathway  of  improvement,  or  even  retrograded ;  while  the  inhabitants 
of  Europe,  though  entering  much  later  into  the  career  of  civilization, 
promptly  surpassed  their  predecessors,  and  raised  themselves  to  a  hight 
that  the  former  were  never  able  to  attain. 

Hippocrates  signalized  this  remarkable  phenomenon  in  his  treatise  ou 
"Airs,  Waters,  and  Places."  He  sought  its  cause,  and  traced  it  with 
an  admirable  sagacity,  to  the  combined  influences  of  climate,  manners, 
and  government.  A  temperature,  mild  and  uniform,  which  dispenses  in 
man  to  provide  against  sudden  vicissitudes  of  the  seasons ;  a  soil,  un- 
broken and  fertile,  from  which  he  obtains,  with  but  little  labor,  a  suffi- 
cient alimentation ;  the  use  of  food  almost  exclusively  vegetable ;  a- 
despotic  government,  under  which  the  fortunes  and  the  lives  of  the 
people  are  at  the  mercy  of  the  caprices  of  the  monarch,  where  advance- 
ment  depends   on  favor   rather  than   on   merit :    civil   and  religious 


GENERAL  CONSIDERATIONS.  79 

institutions,  which  parcel  off  the  various  classes  of  society,  like  flocks, 
and  assign  to  each  individual,  from  his  birth,  a  rank  out  of  which  it 
is  impossible  for  him  to  move  ;  all  these  circumstances  appeared  to  the 
the  philosopher  of  Cos,  eminently  calculated  to  enervate  the  physical 
constitution  of  the  people,  to  blunt  their  intelligence,  and  extinguish 
their  moral  energy  ;  while  the  opposite  conditions,  such  as  a  tempera- 
ture extremely  variable,  a  broken  soil,  and  a  government  surrounded 
by  liberal  institutions,  seemed  to  him  calculated  to  produce  on  the  body 
and  the  mind,  effects  entirely  contrary.  In  this  he  explains  the  cause 
of  the  superiority  of  the  nations  of  Europe  over  the  greater  part  of  those 
of  Asia. 

To  these  considerations,  taken  outside  of  the  nature  of  man,  the 
modern  physiologists  add  others,  very  important,  drawn  from  his  ori- 
ginal conformation.  They  teach,  from  numerous  observations,  and  in 
particular  from  the  researches  in  comparative  anatomy,  that  the  develop- 
ment of  the  intellectual  faculties  is  always  proportionate  to  the  volume 
of  the  cerebral  hemispheres,  and  especially  of  the  anterior  lobes.  This 
law,  they  say,  governs  not  only  all  the  species  and  varieties  of  the  great 
family  of  man,  but  also  the  entire  animal  scale.  Now  in  this  anatomi- 
cal aspect,  it  appears  that  the  Mongolian  race,  to  which  belong  the 
natural  inhabitants  of  Egypt,  the  East  Indies,  and  China,  ^are  much 
less  in  these  physical  advantages  than  the  Caucassian  race,  from  which, 
most  of  the  inhabitants  of  Europe  take  their  origin.  It  would  follow 
from  this  view,  that  the  inferiority  of  the  first,  compared  with  the  last, 
holds  to  an  imperfect  innate  organic  constitution,  as  much,  at  least,  as 
to  external  influences. 

However  true  or  false  this  theory  may  be,  the  ancient  Greeks  found' 
themselves,  at  the  commencement  of  the  period  which  we  named  Philo- 
sophic, in  the  most  favorable  condition,  according  to  the  views  of  Hip- 
pocrates, for  the  development  of  their  physical  and  moral  faculties. 
They  occupied,  besides  Greece  proper,  Rhodes,  Crete,  Sicily,  and  a 
multitude  of  other  islands.  They  possessed  an  immense  extent  of 
coast  in  Europe,  Asia,  and  Africa.  The  Hellenic  peninsula,  which 
does  not  equal  in  extent  the  half  of  France,  had  an  exceedingly  irreg- 
ular and  broken  surface ;  great  extremes  of  temperature,  mountains 
covered  with  eternal  snow,  narrow  gorges  excavated  by  torrents,  fertile 
plains,  delightful  valleys,  arid  hillsides  scorched  by  the  rays  of  a  tropical 
sun,  a  sea  subject  to  frequent  tempests,  a  coast  full  of  dangers,  and. 
indented  with  deep  gulfs.  In  short,  this  nation  was  endowed,  if  wc 
judge  from  their  statuary,  with  the  most  noble  physical  forms,  calcu- 
lated to  display,  according  to  modern  views,  beauty,  genius,  and  power.. 

The  political  institutions  prevalent  in  most  of  the  Grecian  states, 


80  PHILOSOPHIC   PERIOD. 

were  in  harmony  with  that  happy  concourse  of  circumstances  to  which 
we  have  alluded.  Nearly  everywhere  a  republican  government  or  a 
limited  monarchy  had  replaced  the  absolute  power  of  kings.  As  the 
inhabitants  were  not  very  numerous  in  these  small  states,  they  could 
know,  watch,  and  mutually  estimate  each  other,  so  that  public  opinion 
was  not  much  exposed  to  error.  Public  honor  generally  followed  merit, 
and  to  obtain  this  it  was  necessary  to  show  oneself  worthy  by  some 
important  act,  by  skill  in  counsel,  by  extraordinary  talents,  or  by  emi- 
nent virtue. 

The  era  of  brute  force,  of  combat  hand  to  hand  with  monsters  and 
brigands,  had  passed  away,  and  the  reign  of  intelligence,  of  strategy 
in  war  and  in  politics,  was  conspicuous.  The  Mythological  heroes  whose 
prodigious  labors  were  so  much  boasted,  such  as  a  Hercules,  a  Perseus, 
and  a  Bellerophon,  were  succeeded  by  those  great  men,  whose  lofty  acts 
have  been  celebrated  in  history,  such  as  Leouidas,  Miltiades,  and 
Themistocles. 

The  gymnasiums  were  no  longer,  as  formerly,  places  devoted  entirely 
to  bodily  exercise  ;  they  were  surrounded  by  halls  and  porticos  where 
philosophers,  rhetoricians,  artists,  and  physicians,  assembled  to  hold 
their  schools  and  dispute  on  questions  of  art. 

The  theaters  and  public  amusements,  also,  realized  this  social  transfor- 
mation. Strength  and  address  no  longer  solely  excited  the  admiration 
of  the  multitude  ;  a  taste  had  been  created,  at  least  in  some  cities,  for 
the  charms  of  the  productions  of  the  mind.  We  touch  that  epoc  when 
the  spectators  of  the  Olympic  games,  filled  with  enthusiam  on  hearing 
the  reading  of  the  books  of  Herodotus,  gave  to  each  of  them  the  name 
of  one  of  the  nine  muses.  If  Crotona  was  proud  in  sending  the  most 
vigorous  Athletus  to  those  national  solemnities  which  attracted  a  con- 
course from  all  Greece,  Athens  was  not  less  so  of  the  crowns  that  were 
obtained  there  by  her  poets,  her  painters,  and  her  sculptors. 

Gradaully  science  unrobed  herself  of  the  grave  and  mysterious  forms 
with  which  she  had  always  been  clothed  in  the  East,  to  assume  a  dress 
less  severe  and  more  transparent,  and  of  the  taciturnity  that  she  had 
had  in  Egypt,  to  become  more  communicative  and  even  somewhat 
loquacious.  The  vestiges  of  this  antique  Egypto-Indian  civilization 
which  had  served  as  a  model  for  that  of  Greece  was  insensibly  dis. 
appearing.  Soon  the  sages  of  Greece  ceased  their  journeys  in  search 
of  light  in  foreign  countries,  for  their  own  country  became  in  its  turn 
a  center  of  illumination  for  all  nations. 

Pythagoras  affords  us  the  last  celebrated  example  of  distant  peregri- 
nations in  search  of  wisdom.  He  is,  also,  the  last  of  the  sages  who  have 
transmitted  their  doctrines  in  an  unusual  language,  and  who  made  use 


PYTHAGORAS.  81 

of  hieroglyphical  writing.  As  lie  was  desirous  to  continue  in  Greece 
the  traditions  of  the  Egyptian  school,  the  history  of  his  life,  and  of  the 
society  that  he  founded,  interests  us  in  a  very  high  degree ;  for  it  shows 
us  the  contrast  and  the  transition,  from  an  old  to  a  new  and  more  perfect 
social  state. 

Born  at  Samos,  one  of  the  most  flourishing  of  the  islands  of  the  ^gean 
sea,  Pythagoras  was,  at  first,  an  Athlete,  but  having  heard  one  day 
Pherecydes  lecture  on  the  immortality  of  the  soul,  he  was  so  charmed, 
that  he  renounced  every  other  occupation  to  devote  himself,  exclusively, 
to  philosophy.  After  having  followed  the  course  of  this  eminent  master 
for  some  time,  he  felt  desirous  of  knowing,  for  himself,  the  customs  and 
manners  of  other  nations.  He  travelled  in  Egypt,  in  Phenicia,  and  in 
Chaldea ;  and  it  is  said,  that  he  pushed  his  travels  as  far  as  India, 
where  he  communed  with  the  Brahmins  and  Magi,  and  was  initiated 
into  the  secrets  of  their  worship,  laws  and  doctrines.  After  a  great 
number  of  years  employed  in  schooling  his  mind  by  the  practice  of  vir- 
tue, and  enriching  it  with  the  most  varied  knowledge,  he  returned  to 
his  country,  and  was  honorably  received  by  the  tyrant  Polycrates,  who 
endeavored  to  eiface  his  usurpation  by  the  mildness  of  his  government, 
and  by  the  prosperity  he  brought  upon  the  citizens  who  had  become  his 
subjects.  Notwithstanding  the  efforts  of  the  usurper,  the  philosopher, 
not  being  able  to  habituate  himself  to  the  servitude  of  his  country,  left 
it  to  seek  an  asylum  in  some  other  land,  from  which  liberty  had  not 
been  banished.  Whilst  traversing  the  Peloponnesus,  he  assisted  at  the 
Olympic  games,  and  being  recognized,  he  was  greeted  with  universal 
acclamations. 

Erom  this  place  he  sailed  for  the  southern  part  of  Italy,  or  Great 
Greece.  He  landed  at  Crotona.  say  the  biographers,  and  lodged  with 
Milo,  the  Athlete,  with  whom  his  family  was  united  by  the  bond  of 
hospitality.  It  was  in  this  city  that  he  commenced  his  mission  as  a 
reformer.  His  discourses  had  such  success  that  in  a  very  little  time  he 
drew  around  him  a  great  number  of  disciples.  He  required  of  them  a 
very  severe  noviciate,  which  lasted  for  five  or  six  years.  During  the 
season  of  trial,  they  were  required  to  abstain  almost  entirely  from  con- 
versation. They  ate  in  common,  using  a  very  frugal  diet ;  they  assisted 
the  master  in  his  lessons,  executed  the  orders  they  received  without 
making  any  observations,  and  in  a  word,  led  a  pure,  modest,  temperate 
life.  Those,  only,  who  persevered,  were  admitted  to  a  participation  in 
the  mysteries  of  the  order. 

The  veneration  of  the  disciples  of  Pythagoras,  for  their  master,  was 
so  great,  that  many  sold  their  property  and  gave  the  proceeds  to  him, 
for  the  general  good. 


82  PHILOSOPHIC   PERIOD. 

An  end  was  put  to  all  discussion  by  the  words,  "  The  master  has 
said  it."  This  philosopher  joined  to  an  immense  knowledge,  an  easy 
and  attractive  elocution.  It  is  said,  that  he  invented  the  theorem  of 
the  square  of  the  hypothenuse ;  that  he  was  the  first  to  divide  the  year 
into  365  days,  6  hours;  that  he  had  an  idea  of  our  planetary  system; 
that  is  to  say,  that  he  suspected  the  movement  of  the  other  planets 
around  the  sun.  But  the  greater  part  of  these  assertions  have  no  solid 
foundation.  The  sect  of  which  he  was  the  founder,  is  called  the  Italian, 
from  the  name  of  the  country  in  which  it  originated. 

Pythagoras  did  not  limit  his  teachings  to  the  city  of  Crotona :  he 
visited  the  principal  cities  of  Great  Greece,  among  others,  Heraclea. 
Tarentum,  Metapontum,  and  established  Communities  in  each  of  them, 
subject  to  the  common  rules.  These  institutions  exercised,  at  first,  the 
happiest  influence:  a  sensible  reform  was  developed  in  the  dissolute 
manners  of  the  inhabitants  of  those  cities.  The  Pythagorians  gained 
the  esteem  of  the  magistrates  and  the  people ;  they  were  consulted  on  all 
difficult  matters,  and  the  superiority  of  their  knowledge,  joined  to  a  rare 
abnegation,  drew  upon  them  the  public  confidence. 

It  appears  that  their  success  rendered  them  bold.  Some  of  them 
began  to  mingle  in  intrigues  and  cabals,  which  was  against  the  formal 
precept  of  their  master,  who  often  repeated  to  them,  "abstain  from 
party  interests,  according  to  the  general  understanding  of  that  term, 
and  do  not  frequent  public  assemblies  at  periods  of  elections."  The 
politicians,  who  felt  that  their  presence  was  injurious  to  their  projects, 
accused  them  of  aspiring  to  domination  in  public  afi'airs  ;  the  priesthood 
launched  their  anathemas  at  them,  because  they  did  not  share  the  super- 
stitious prejudices  of  the  multitude.  The  simplicity  of  their  costume, 
their  symbolical  language,  their  habitual  silence,  their  avoidance  of 
pleasure  parties,  and  every  thing,  even  to  the  purity  of  their  lives, 
became  a  subject  of  reproach  or  umbrage.  Mobs  were  excited  against 
them ;  they  were  menaced  and  pursued  by  the  populace  in  every  city, 
and  because  they  were  obliged  to  seek  concealment,  in  order  to  save 
their  lives,  the  greater  number  expatriated  themselves :  in  this  way 
their  society  was  broken  up,  even  during  the  life  time  of  its  founder, 
who  never  again  attempted  its  reconstruction. 

Before  detailing  the  results  of  the  dispersion  of  the  Pythagorians,  we 
shall  present  a  sketch  of  the  doctrine  of  their  chief,  a  doctrine  very 
important  in  the  history  of  medicine  and  philosophy ;  for  it  is  the 
source  of  many  theories  which  have  exerted  a  great  influence  on  the 
march  of  the  human  mind ;  and  moreover,  it  is  a  key  to  the  pretended 
occult  sciences,  the  reign  of  which  extended  down,  even  as  far  as  the 
close  of  the  eighteenth  century. 


DOCTRINE    OF   PYTHAGORAS.  83 

CHAPTEK    I. 
DOCTRINE   OF    PYTHAGORAS. 

There  remains  to  us  of  the  memorials  of  antiquity,  concerning  that 
doctrine,  but  a  single,  very  incomplete,  and  very  obscure  fragment.  It 
is  a  collection  of  sentences,  which  are  attributed  to  Lysis,  a  Pythagorian 
philosopher,  and  the  friend  and  preceptor  of  Epaminondas ;  but  it 
would  be  impossible  for  us  to  avail  ourselves  of  the  doctrines  of  this 
precious  document,  without  the  able  commentary  of  M.  Eabre  d'  Olivet. 
Thanks  to  this  skillful  interpreter,  we  are  able  to  lift  a  corner  of  the 
veil  that  covers  the  famous  dogmas  of  the  philosopher  of  Samos." 

This  commentator,  in  order  to  give  a  general  idea  of  the  nature  of  his 
work,  explains  himself  as  follows:  "  I  have  followed,  in  my  translation, 
the  Greek  text,  as  it  is  given  at  the  head  of  the  Commentary  of  Hiero- 
cles,  expounded  by  the  son  of  Casaubon,  and  interpreted  in  Latin  by 
Carterius:  London  edition,  1673.  This  work,  as  all  those  that  remain 
to  us  of  the  ancients,  has  been  the  subject  of  a  great  number  of  critical 
and  grammatical  constructions.  The  authenticity  of  the  greater  part 
of  it  seems  to  be  unquestioned,  and  although  there  are  some  variations 
of  opinion,  they  are  of  too  little  importance  for  me  to  pause  and  consider 
at  this  time.  Nor  is  it  my  place  to  do  so ;  beside,  each  one  must  do  his 
own  work. 

The  labor  of  the  grammarians  is  complete,  or  must  so  be  regarded ; 
for  nothing  would  ever  be  finished,  if  we  continually  recommence  our 
investigations  at  the  same  point,  without  being  willing  to  rely  upon  the 
previous  researches  of  others. 

As  far  as  possible,  I  have  extracted  literally  from  the  Commentary  of 
d'Olivet  all  that  I  give  of  the  system  of  Pythagoras ;  nevertheless,  for 
the  purpose  of  abbreviating,  I  have  contented  myself  sometimes  to  ana- 
lyze certain  passages,  which  I  have  indicated  by  the  suppression  of  the 
brackets. 

"  Pythagoras  considered  the  universe  as  a  unit  animated  by  Divine 
intelligences,  each,  according  to  its  perfections,  occupying  its  proper 
sphere.  It  was  he  who  designated,  first  of  all,  this  totality  by  the  Greek 
word  Kosmos,  to  express  the  beauty,  order,  and  regularity  that  therein 
reign.  The  Latins  translate  this  word  by  mundus.  from  which  we  have 
derived  the  French  word  monde.     It  is  from  unity,  considered  as  the 


^  Vers  Dores  de  Pythagore,  explained  and  translated  into  French  verse,  by  M. 
d'Olivet.    Paris,  1813, 


84  PHILOSOPHIC   PERIOD. 

principle  of  the  world,  that  we  get  the  word  universe,  which  we  apply 
to  it. 

"  Pythagoras  considered  unity  as  the  essential  principle  of  all  things. 
He  designated  God  by  the  figure  1,  and  matter  by  2 ;  so  he  expressed 
the  universe  by  12,  because  this  results  from  the  juxtaposition  of  the 
figures  1  and  2."     (3e  Examen.) 

As  on  the  other  hand,  the  number  1 2  results  from  the  multiplication 
of  3  by  4,  the  philosopher  conceived  the  universe  composed  of  three  dis- 
tinct worlds  bound  closely  to  each  other,  each  of  which  was  developed  in 
four  concentric  spheres.  The  inefi'able  Being  who,  placed  in  the  com- 
mon ceuter  of  these  twelve  spheres,  filling  them  all  without  being  com- 
prehended by  any  of  them,  was  God. 

The  four  spheres  from  which  are  formed  each  one  of  its  three  distinct 
worlds,  correspond  to  four  elementary  modifications  of  inert  or  amorphous 
matter.  These  primitive  modifications  are  called  fire,  air,  earth,  and 
water,  and  are  the  elements  which  constitute  all  material  substances. 

"  The  application  of  the  number  12  to  express  the  universe,  was  not 
an  arbitrary  invention  of  Pythagoras ;  it  was  common  to  the  Chaldeans 
and  Egyptians,  from  whom  he  had  received  it,  and  also  to  the  chief  na- 
tions of  the  earth.  It  was  the  origin  of  the  institution  of  the  Zodiac,  the 
division  of  which  into  twelve  constellations  has  been  found  to  exist 
everywhere,  from  time  immemorial  "     (3e  Examen.) 

"  According  to  this  system,  absolute  unity,  or  God,  was  considered  the 
spiritual  soul  of  the  universe — the  essence  of  being — the  light  of  lights. 
Between  the  Supreme  Being  and  man  an  incalculable  chain  of  interme- 
diate beings  was  conceived,  whose  perfections  or  attributes  decreased  in 
proportion  to  their  separation  from  the  creative  principle."'"'  (3e  Examen.) 

"  Pythagoras,  in  conceiving  this  spiritual  hierarchy  as  a  geometrical 
progression,  regarded  the  beings  which  compose  it  under  harmonious 
relations,  and  founded,  by  analogy,  the  laws  of  the  universe,  on  those  of 
music.  He  termed  harmony  the  movement  of  the  celestial  spheres,  and 
employed  figures  to  express  the  faculties,  relations,  and  influences  of  the 
diflferent  beings."     (3e  Examen.) 

Everything  that  appeared  to  have  an  existence  proper,  was  supposed 
to  proceed  from  the  reunion  of  three  modalities.  Thus,  the  universe, 
the  grand  whole  or  macrocosm,  included,  as  we  have  said,  three  second- 
ary worlds.  Man,  the  little  world,  or  microcosm,  was  composed,  accord- 
ing to  Pythagorean  views,  of  a  body,  soul,  and  spirit,  manifested  by 
three  distinct  faculties :  viz.,  sensibility,  thought,  and  intelligence.     On 

'^"'  The  author  explains  in  what  cases  secondary  spirits  were  angels,  deities, 
intelligences,  or  demons. 


DOCTRINE   OF   PYTHAGORAS.  85 

the  other  hand,  each  ternary,  from  the  one  that  embraced  immensity,  to 
the  one  that  constituted  the  feeblest  individual,  being  comprised  in  a 
perfect  whole  —  a  unity,  relative  or  absolute  —  concurred  to  form  the 
quaternary  or  the  sacred  tetrad.   (3e  and  12e  Examen.) 

Consequently,  1  represented  the  active  and  hidden  principle  of  all 
things;  2,  its  passive  principle,  or  matter;  3,  the  totality  of  the  facul- 
ties: and  4,  the  plenitude  of  its  essence.  The  quaternary,  was  the 
general  type  of  all  living  beings,  manifesting  themselves  by  facultative 
modifications.  It  could  thus  become  the  representative  sign  of  any  being 
whatever ;  but  the  beiag  to  which  it  was  most  ordinarily  applied  was 
man.   (Be  and  12e  Examen.) 

"  The  language  of  numbers,  which  Pythagoras,  after  the  example  of 
ancient  sages,  frequently  employed,  is  now  lost.  The  fragments  of  it 
which  remain,  serve  rather  to  prove  its  existence,  than  to  furnish  any  light 
on  its  elements ;  for  they  who  wrote  these  fragments,  used  a  language 
that  they  supposed  known,  in  the  same  manner  that  our  modern  savans 
do,  when  they  employ  algebraic  characters.  It  would  certainly  be  ridicu- 
lous, before  having  acquired  any  notion  of  these  algebraic  signs,  to 
attempt  to  explain  a  problem  written  in  them  ;  or  what  would  be  worse 
still,  to  attempt  to  employ  them,  without  knowing  their  value,  to  lay 
down  a  proposition.  But  this  is  precisely  what  has  been  attempted, 
often,  relative  to  the  language  of  numbers.  Some  have  pretended,  not 
only  to  explain  it,  before  having  learned  it,  but  even  to  write  it  —  thus 
rendering  themselves  contemptible.  The  learned,  finding  this  language 
thus  travestied,  very  naturally  despised  it,  and  very  unreasonably 
extended  their  contempt  to  the  ancients  who  made  use  of  it ;  acting  thus, 
in  this  case  as  in  many  others :  creating,  themselves,  the  alleged  stupidity 
of  the  antique  sciences,  and  ended  by  saying,  '  antiquity  was  stupid.'  "^'■* 
(Be  Examen.) 

The  philosopher  of  Samos  admitted  two  eternal,  uncreated  essences : 
namely,  spirit  and  matter ;  and  by  the  agency  of  these  two  principles  he 
explains  the  various  phenomena  of  sensibility,  intelligence,  and  thought. 
"  Whenever  any  one  has  pretended,  or  shall  pretend  to  found  the  universe 
on  the  existence  of  one  sole  nature,  material  or  spiritual,  and  deduces 
from  the  hypothesis,  the  explanation  of  all  phenomena,  he  encounters, 
and  always  will  encounter  insurmountable  difficulties.  It  has  always 
been  by  asking  what  is  the  origin  of  good  and  evil,  that  an  irresistible 
overthrow  has  been  given  to  all  systems  of  this  kind,  from   Moschus, 


'^  The  little  sketch  that  we  have  given  above  of  the  language  of  numbers,  will 
serve,  imperfect  as  it  is,  to  give  an  idea  of  the  importance  that  the  ancients 
attached  to  ternary  and  quaternary  periods,  in  the  determination  of  critical  days. 


86  PHILOSOPHIC   PERIOD. 

Leucippus,  and  Epicurus,  down  to  Spinosa  and  Leibnitz :  from  Parmeni- 
dcs,  Zeno  of  Elca,  and  Chrysippus,  down  to  Berkley  and  Kant." 
(31e  Examen.) 

"  Homogenity  in  nature  was,  with  the  unity  of  God,  one  of  the  great- 
est secrets  of  the  mysteries.  Pythagoras  founded  this  homogenity  on 
the  unity  of  the  spirit,  with  which  it  is  penetrated,  and  from  which  all 
our  souls,  according  to  him,  took  their  origin.  This  dogma,  which  he 
had  received  from  the  Chaldeans,  and  the  priests  of  Egypt,  was  admit- 
ted by  all  the  sages  of  antiquity,  as  is  amply  shown  at  length  by  Stan- 
ley and  the  judicious  Beausobre.  Those  sages  established  a  harmony 
in  principle,  and  a  perfect  analogy  between  heaven  and  earth,  the  intel- 
ligible and  the  sensible,  divisible  and  indivisible  substances,  in  such  a 
manner  that  what  transpires  in  one  of  the  regions  of  the  universe,  or  of 
the  modifications  of  the  primordial  ternary,  was  the  exact  image  of  what 
transpired  in  the  other.  Beside,  I  must  say,  that  it  is  on  the  homogen- 
ity of  nature  that  rest,  in  principle;  all  the  occult  sciences,  of  which 
the  four  principal  ones  are  connected  with  the  human  quaternar,  beign 
theurgy,  astrology,  magic,  and  chemistry." — (28e  Examen.) 

"  Man,  in  this  system,  was  considered  as  holding  the  middle  between 
intellectual  and  sensible  things,  the  last  of  superior  and  the  first  of 
inferior  beings,  free  to  move  upward  or  downward,  as  influenced  by  the 
passions  that  control  the  power  of  the  will  to  ascend  or  descend.  Some- 
times they  bring  him  into  union  with  immortals,  and,  by  his  return 
to  virtue,  enable  him  to  recover  his  proper  position  ;  and  again,  some- 
times replunging  him  into  mortal  association,  and  by  transgression  of 
the  divine  laws,  cause  him  to  be  stripped  of  his  dignity.  It  is  based 
on  this  rule,  that  we  find  everywhere,  though  differently  explained,  the 
foundation  of  the  dogma  of  the  transmigration  of  souls.  This  dogma, 
explained  in  the  mysteries  of  antiquity,  and  received  by  all  the  people, 
has  been  so  disfigured  by  what  the  moderns  have  called  metempsycho- 
sis, that  it  would  surpass  very  much  the  limits  of  these  comments  to 
give  it  an  explanation  that  could  be  understood." — (32e  Examen.) 

"This  same  philosopher  taught  that  the  soul  has  a  body,  which  is 
given  to  it  according  to  its  good  or  bad  nature,  by  the  interior  labor  of 
its  faculties.  He  calls  this  body  the  subtle  car  of  the  soul,  and  says 
that  the  mortal  body  is  only  a  gross  envelope." — (37e  Examen. V-' 

The  indefinite  perfectibility  of  nature,  founded  on  the  homogenity  of 
its  essence,  is  also  one  of  the  dogmas  of  the  Pythagorian  school,  that 
moderns  have  appropriated,  and  which  they  have  fortified  by  considera- 


'•■  We  shall  show,  at  proper  time  and  place,  the  analogy  that  exists  between  this 
doctrine  and  that  of  the  monads  invented  by  Leibnitz. 


DOCTRINE  OF   PYTHAGORAS.  87 

tions  nearly  demonstrative.  Among  those  who  have  developed  it  with 
most  success,  we  cite  Leibnitz,  Lecat,  Ch.  Bonnet,  BufFon,  Linseus,  Kant, 
Schelling,  and  lastly,  the  author  of  the  articles,  "  Nature  "  and  "  Ani- 
mal," of  the  Nouveau  Dictionaire  (VHistoire  Naturelle.  The  following 
is  his  explanation  :    (.35e  Examen.) 

"  All  animals  and  plants  are  only  modifications  of  an  original  ani- 
mal or  vegetable.  Man  is  the  point  of  union  between  divinity  and 
matter,  connecting  heaven  and  earth.  The  light  of  wisdom  and 
intelligence  that  beams  in  his  thoughts,  is  reflected  on  nature.  He  is 
the  bond  of  co  imunication  between  all  beings. ''■' 

"  There  may  have  been  a  time  when  the  insect,  the  shell-fish,  or  the 
unclean  reptile,  knew  no  master  in  the  universe,  and  found  itself  at  the 
head  of  organized  beings.  Who  knows  if,  in  the  eternal  night  of  ages, 
the  scepter  of  the  world  shall  not  pass  from  the  hands  of  man  into 
those  of  a  being  more  perfect  and  worthy  to  bear  it.  It  may  be  that 
the  race  of  negroes,  now  secondary,  was  once  the  ruler  of  the  earth,  be- 
fore the  white  race  was  created.  If  nature  has  successively  accorded 
empire  to  the  species  more  and  more  perfect  which  she  has  created, 
why  should  she  stop  now?  Who  shall  define  the  limits  of  her 
power  ?  She  is  ruled  by  God  alone,  and  it  is  his  might  and  hand  that 
governs  her."-- 

Attracted  by  the  grandeur,  beauty,  and  connection  of  these  ideas,  I 
have  given  to  the  extracts  of  the  doctrine  of  Pythagoras  a  more  con- 
siderable extension  than  I  was  willing  to,  but  the  precious  illumina- 
tion that  is  found  there,  on  a  multitude  of  things  and  opinions  that  are 
supposed  new,  have  repaid  the  reader,  I  hope,  and  will  recomj^ense  him 
more  and  more  hereafter.  A  system  which  embraces  and  unites,  by  a 
common  bond,  God,  the  universe,  time,  and  eternity ;  which  includes 
an  explanation  of  all  the  phenomena  of  nature,  if  not  true,  at  least 
acceptable,  at  an  epoch  when  nothing  could  be  put  in  parallel  with  it. 
but  the  gross  mythology  of  pagan  priests — such  a  system,  I  say,  was 
well  calculated  to  captivate,  at  once,  the  imagination  and  understand- 
ing. It  is  now  easy  to  conceive  the  admiration  and  enthusiasm  of  the 
adepts,  in  proportion  to  their  progress  in  the  autopsy  of  the  mysteries. 
and  their  submission,  respect,  and  gratitude  toward  the  superior  man 
who  initiated  them  into  such  lofty  conceptions,  seems  entirely  reasonable 
and  natural. 

^  ■ 

'See  the  "Nouveau  Diet.  d'Hist.  Nat.,"  at  the  word  Natitee. 
*  Same  work,  at  the  word  Animal. 


88  PHILOSOPHIC   PEKIOD. 

CHAPTER    II. 
PERIODIC    PHYSICIANS. 

When  the  storm  of  persecution  had  dissolved  the  Pythagorian 
societies,  the  members  that  composed  it  were  scattered  in  different  parts 
of  Greece.  Being  no  longer  held  by  the  bond  of  the  community,  many 
of  them  revealed  in  whole  or  in  part  the  secrets  of  their  doctrine,  and 
to  this  circumstance  we  owe  the  little  light  that  we  possess  on  the 
subject. 

A  great  number  of  the  disciples  of  Pythagoras  became  illustrious  in 
different  careers,  but  we  can  only  speak  in  this  work  of  those  who 
followed  the  practice  of  Medicine.  History  states  that  the  latter  first 
introduced  the  custom  of  visiting  their  patients  in  their  own  houses ; 
that  they  went  from  city  to  city,  and  from  house  to  house,  fulfilling  the 
duty  of  physicians,  as  is  done  at  present.  On  this  account  they  were 
called  periodic,  or  ambulant  physicians,  in  opposition  to  the  Ascle- 
piadae,  who  were  consulted  by  and  treated  the  sick  only  in  the  temples. 
As  to  the  charlatans  who  retailed  drugs  in  shops,  or  at  market,  it  appears 
that  they  have  never  had  a  rank  in  the  medical  hierarchy,  however 
numerous  they  may  have  been  at  certain  epochs. 

Among  the  Pythagorians  who  cultivated  Medicine,  is  cited  Alcmoeon, 
of  Crotona,  who  is  said  to  have  written  on  anatomy  and  physics.  It 
is  pretended  that  he  was  the  first  to  dissect  animals  ;  but  this  is  quite 
doubtful,  as  Anaxagoras  and  Democritus  were  already  much  earlier 
occupied  than  he,  in  zoology.  At  any  rate,  we  are  not  able  now  to 
judge  either  of  the  rsality  or  merit  of  his  discoveries,  as  no  part  of  his 
writings  have  come  down  to  us.* 

Empedocles,  of  Agrigentum,  was  more  famous  than  Alcmoeon.  Many 
remarkable  cures  are  ascribed  to  him  which  attest  his  sagacity.  Among 
many  instances  that  prove  this,  we  select  the  following.  From  time 
immemorial  pestilential  fevers  ravaged,  periodically,  his  native  city. 
He  observed  that  the  appearance  of  these  fevers  coincided  with  the 
return  of  a  wind  named  Sirocco,  which  blows  in  Sicily,  from  the  east 
and  south.  He  therefore  advised  to  close  by  a  wall  the  narrow  gorge  - 
which  gave  passage  to  this  wind  when  it  blew  on  Agrigentum.  His 
counsel  was  followed,  and  from  that  time  the  pest  ceased  to  make  its 
appearance  in  the  city.  Some  modern  travelers  have  confirmed  this 
remark  ;  among  others,  Doctor  Brayer  has  alluded  to  it,  in  his  excellent 

*  Lauth,  Histoire  de  I'Anatomie,  Strasbourg,  1815,  Liv.  ii. 


THE  PRACTICE  OF  MEDICINE   IN  THE   GYMNASIA.  89 

work,  entitled,  Nine  Tears  of  Residence  in  Constantinople.  The  inhabi- 
tants of  Selinus  were  a  prey  to  an  epidemic  disease.  A  stream,  by  its 
sluggish  course,  filled  the  city  ■with  stagnant  waters,  from  which  were 
evaporated,  daily,  mephitic  vapors.  Empedocles  saw  this,  and  caused 
two  small  creeks  to  be  conducted  into  it.  This  gave  a  new  impulse  to 
the  waters,  which  ceased  to  be  stagnant  and  to  exhale  the  noxious 
effluvia.     The  scourge  disappeared." 

Agrigentum  saw  flourish,  about  the  same  epoch,  another  physician, 
named  Acron,  who  was  not  of  the  sect  of  Pythagoras.  He  rejected  in 
medical  practice  every  species  of  physiological  theory,  and  insisted  upon 
the  value  of  pure  experience  only.  On  this  account  he  is  regarded  by 
some  as  the  chief  of  the  empirists.  But  it  is  impossible  for  us  to 
judge  of  the  value  of  this  opinion,  because,  no  fragment  of  his  writings 
has  come  down  to  us.  All  that  can  be  said,  is,  that  the  separation  of 
physicians  into  several  sects,  each  one  having  principles,  rules,  and  in 
some  sort  distinct  symbols,  did  not  take  place  for  two  centuries  later, 
until  the  establishment  of  the  Alexandrian  school. 


CHAPTER    III. 
THE  PRACTICE  OF  MEDICINE  IN  THE  GYMNASIA. 

It  is  an  incontestible  fact,  that  Medicine  was  practiced  and  taught 
in  the  gymnasiae  of  Greece,  a  long  time  before  the  Asclepiadae  had 
divulged  the  secret  of  their  doctrines.f  There  were  in  these  establish- 
ments three  orders  of  physicians.  A  director  termed  the  gymnasiarch, 
whose  duties  consisted  in  regulating  the  diet  of  the  Athletfe,  and  of  the 
young  men  who  frequented  these  schools ;  a  sub-director,  or  gymnast, 
who  directed  the  pharmaceutic  treatment  of  the  sick  ;  lastly,  subalterns, 
named  jatraliptes,  who  put  up  prescriptions,  annointed,  frictioned,  bled, 
dressed  wounds  and  ulcers,  reduced  luxations,  fractures,  etc. 

Marvellous  stories  are  told  of  the  sagacity  of  the  gymnasiarchs,  in 
discerning  the  slightest  variation  in  the  prescribed  regimen.  They  pre- 
tended to  recognize  by  certain  signs,  if  any  one  had  been  guilty  of  the 


'•'  Diog.  Laert.  in  EmpedocL  Des  Sciences  Occultes,  par  Eus.  Salverte,  Paris, 
1843,  pag.  334. 

t  See  Plato — Laws :  Daniel  Leclerc,  Hist,  de  la  Medicine  :  C.  Sprengel,  Hist, 
de  la  Medicine :  M.  Houdart,  Etudes  Historiques  et  Critiques  sur  la  Doctrine 
d'Hippocrate.    Paris,  1840,  in  8vo. 

6 


90  PHILOSOPHIC   PERIOD. 

slightest  excess  in  drinking  or  eating,  if  the  accustomed  promenade  had 
been  neglected,  or  if  there  had  been  any  indulgence  in  the  pleasures  of 
Venus.  Though  the  author  who  gives  these  accounts  appears  to  ques- 
tion their  veracity,  yet,  nevertheless  they  do  prove  that  the  doctors  of 
the  gymnasise  had  a  high  reputation,  and  possessed  a  certain  degree  of 
skill/' 

History  has  transmitted  to  us  the  names  of  two  gymnasiarchs,  cotempo- 
raries  of  Hippocrates,  but  slightly  older  than  he.  The  first  was  Iccos 
of  Tarentum,  celebrated  for  his  sobriety  and  continence ;  the  proverb, 
"  repast  of  Iccos,"  was  used  to  signify  its  frugal  charactei'. 

The  second  was  Herodicus,  or  Prodicus,  of  Selymbria,  the  same  who 
is  named  in  the  passage  of  Plato  that  we  have  heretofore  quoted  (see 
page  49.)  That  philosopher  accuses  him  of  being  the  first  who  employed 
gymnastics,  in  the  cure  of  diseases,  and  he  reprimands  him  severely  on 
that  occasion  for  having  succeeded  too  well  in  prolonging  the  lives  of 
valetudinarians.  But  the  author  of  the  sixth  volume  of  Epidemics 
reproaches  him  in  an  entirely  opposite  manner  ;  he  accuses  him  of  kill- 
ing his  fever  patients  by  excessive  fatigue.f  It  is  said  that  this  gym- 
nasiarch  obliged  his  patients  to  run  without  stopping,  the  distance  from 
Athens  to  Megara,  and  back  again,  equal  to  three  hundred  and  sixty 
stadia,  which  are  about  equal  to  nine  French  leagues.  These  two  con- 
tradictory reproaches  may  be  easily  explained  ;  for  such  exercise,  though 
useful  in  some  slight  chronic  disorders,  must  have  been  fatal  in  acute 
diseases. 


CHAPTEK    IV. 
SCHOOLS   OF   THE   ASCLEPIADiE. 

We  have  already  said,  that  nearly  everywhere  the  temples  of  Escula- 
pius  were  dispensaries,  in  which  advice  was  given  and  remedies  adminis- 
tered, and  that  the  young  sacerdotal  aspirants  were  there  trained  in 
the  practice  of  Medicine.  The  Asclepiadae  had  preserved,  until  that 
epoch,  the  tradition  of  the  Egypto-Indian  school,  which  only  allowed 
them  to  transmit  their  doctrines  to  the  members  of  their  caste,  and  to 
such  strangers  as  fulfilled  satisfactorily  the  iniatory  tests.  But  when 
the  disciples  of  Pythagoras  had  revealed  the  secret  of  their  mysteries, 
and  the  philosophers  had  dared  to  teach  and  discuss  publically  the 

'■  (Euvres  d'Hippoer.,  2e  livre  des  Prorrlietiques,  at  the  beginniDg. 
I  Ibid,  livre  6«,  aection  3e,  §  48,  edition  of  M.  Littre. 


SCHOOLS   OF   THE   ASCLEPIAD^.  91 

principles  of  morals,  physics,  and  theology,  and  when  the  itinerant 
physicians,  and  the  professors  of  the  gymnasiae,  had  acquired  the  con- 
fidence of  the  public,  the  priests  of  Esculapius  could  no  longer  keep 
silence,  under  the  penrlty  of  seeing  the  scepter  of  Medicine,  which  they 
had  held  until  then,  fall  from  their  hands.  They  were  constrained  to 
bring  to  the  light  of  discussion  the  principles  and  rules  of  their  medical 
practice.  In  this  way  the  science,  whose  aim  is  the  preservation  and 
re-establishment  of  health,  came  forth  at  last  from  the  shadow  of  the 
sanctuary,  and,  vivified  by  public  discussion,  made  in  a  short  time 
extraordinary  progress. 

The  priests  who  served  in  the  temples  at  Cnidus  were  the  first  to 
follow  the  impulse  of  the  age.  They  published  the  little  collection  of 
Cnidian  sentences,  of  which  we  have  already  made  mention.  The  Ascle- 
piadse,  of  Cos,  did  not  hesitate  to  follow  their  example.  They  pub- 
lished a  series  of  treatises,  that  were  collected  at  a  later  period  under 
the  title  of  the  Hippocratic  Works.  This  collection,  which  over- 
shadowed all  the  medical  publications  of  that  period,  constitutes  one  of 
the  most  precious  monuments  of  ancient  Medicine.  But  before  speak- 
ing of  the  matter  which  it  contains,  we  shall  say  a  word  or  two  about 
the  personage  whose  name  it  bears. 


ART.   I.    HIPPOCRATES. 


Hippocrates  was  born  in  the  isle  of  Cos,  of  a  family  in  which  the 
practice  of  Medicine  was  hereditary.  They  pretended  to  trace  their 
ancestry,  on  the  male  side,  to  Esculapius,  and  on  the  female  side  to  Her- 
cules. They  count  as  many  as  seven  of  its  members  that  had  borne  the 
name  of  Hippocrates ;  but  the  most  celebrated  of  all  was  the  second  in  thi? 
range.  His  birth  goes  back  about  as  far  as  the  year  460,  before  Christ. 
But  few  particulars  are  known  of  his  life,  and  we  know  not  his  age  at 
death.  Some  say  he  lived  to  one  hundred  and  ten  years ;  others,  to  ninety  ; 
and  others,  again,  to  eighty,  only.  It  is  certainly  known,  that  he  traveled 
in  Asia  Minor,  Thrace,  Macedonia,  Thessaly,  and  many  other  countries, 
because,  in  various  passages  of  his  writings,  he  names  these  countries, 
and  the  diseases  he  had  occasion  to  treat  in  them.  From  these  it  is 
ascertained  that  he  was  a  cotemporary  of  Socrates,  and  slightly  younger 
than  he ;  therefore,  he  belongs  to  the  famous  age  of  Pericles,  when  the 
sciences  and  arts  attained,  in  Greece,  so  high  a  degree  of  splendor. 

The  isle  of  Cos,  now  Stan-co,  situated  between  Milet  and  Ehodes,  not 
far  from  the  coast  of  Ionia,  was  favored  with  a  delicious  climate,  and. 
in  former  times,  was  considered,  also,  as  one  of  the  most  salubrious 


92  PHILOSOPHIC   PERIOD. 

countries ;  but  it  has  lost  its  antique  reputation  since  it  has  been  under 
the  dominion  of  the  Turks,  for  it  is  now  regarded  as  one  of  the  most 
unhealthy  countries.  It  possessed  then  a  temple  dedicated  to  Esculapius, 
and  a  Medical  school,  which  was  the  most  celebrated  of  all  the  Ascle- 
pidian  schools.  Hippocrates  was  thus  placed  under  very  favorable 
circumstances  to  receive  a  most  careful  and  complete  Medical  education. 
Nevertheless,  he  was  not  satisfied  with  this  domestic  instruction.  He 
visited  the  principal  Greek  cities  of  Europe  and  Asia,  communing  with 
philosophers,  examining  the  gymnasise,  giving  attention  to  all  persons 
who  asked  his  services,  collecting,  at  all  points,  observations  on  special 
diseases,  epidemic  constitutions,  also,  on  the  influence  of  manners, 
climate,  regimen,  etc. 

After  his  return  to  his  native  country,  being  now  rich  in  the  materials 
he  had  collected,  and  especially  in  those  that  his  ancestors  had  amassed 
for  a  considerable  length  of  time,  he  published  those  immortal  works 
that  astonished  the  world,  and  made  the  physical  science  of  man,  one  of 
the  most  important  branches  of  Natural  Philosophy.  Already  whilst 
living,  he  had  an  unequal ed  renown  in  his  profession.  Plato,  his 
cotemporary,  and  even  Aristotle  himself,  rest  on  his  authority  when 
referring  to  the  organization  of  the  human  body.  The  habit  of  calling 
Medicine  the  Art  of  Esculapius,  was  gradually  lost,  and  learned  men 
more  frequently  spoke  of  it  as  the  Science  of  Hippocrates. 

His  sons,  son-in-law,  and  grand-children,  followed  the  same  career, 
and  added  much  to  his  professional  labors.  But  the  greater  number 
of  them  published  their  writings  in  his  name,  either  to  honor  his  memory, 
or  to  obtain  more  weight  for  their  opinions  and  precepts,  or  to  conform 
.to  a  usage  immemorial  in  clerical  families,  or,  for  all  these  three  reasons 
together:  thus,  even  in  a  short  time  after  the  death  of  the  great  Hippoc- 
rates, it  had  already  become  very  difficult  to  distinguish  his  own  works 
•from  those  of  his  disciples.  This  difficulty  continued  to  increase  in 
proportion  as  the  texts  became  impaired  by  the  ignorance  or  inexactness 
of  copyists,  and  above  all  by  the  bad  faith  of  bookmongers.  These, 
accoi'ding  to  Galen,  had  not  the  least  scruple  in  the  world,  to  write  the 
iname  of  Hippocrates  on  the  medical  writings  of  unknown  or  obscure 
authors. 

By  this  fraud  they  augmented,  very  much,  the  venal  value  of  the 
volumes  which  they  had  in  possession  ;  and  on  this  account,  says  Galen, 
they  had  frequent  recourse  to  it,  especially  at  an  epoch  when  the  sove- 
reigns of  Egypt  and  Pontus,  rivals  in  zeal  for  the  increase  of  the  libra- 
ries they  had  founded,  purchased  in  every  country  all  the  books  that 
■  could  be  procured,  and  paid  for  them  a  price  proportional  to  the  reputation 
-of  the  authors.     The  savans  having  charge  of  the  library  at  Alexandria 


II 


SCHOOLS   OF   THE   ASCLEPIAD^.  &3 

very  soon  discovered  the  fraud ;  so  from  tte  commencement  of  that 
collection,  they  were  careful  to  place  in  a  separate  column,  the 
writings  which  appeared  to  them  to  have  really  come  from  the  pen  of 
the  physician  of  Cos  ;  and  they  designated  them  as  volumes  of  the  little 
tablet,  za  zx  zoo  /jtr/oo'j  Tzcuaxcowj.  This  disposition  of  them  in  the 
library,  was  still  seen  in  the  time  of  Galen. 

A  great  number  of  commentators  have  attempted  to  arrange  a  cata- 
logue of  the  legitimate  writings  of  Hippocrates  ;  but,  guided  by  different 
views,  and  resting  on  diverse  documents,  they  have  all  varied  in  their 
enumeration.  Galen  gives  a  list  of  these  writings  that  differs  from  all 
preceding  ones ;  and  the  moderns,  in  their  turn,  have  each,  after  his 
own  notion,  changed  the  list  of  Galen.  After  the  learned  researches  of 
Mercuriali,  Foes,  Grimm,  Gruner,  Ackermann,  Sprengel,  and  many  others, 
one  might  suppose  the  subject  exhausted.  Nevertheless,  at  this  moment 
there  appears  an  edition  of  the  works  of  Hippocrates,  in  French,  in  which 
the  author,  M.  Littre,  in  a  remarkable  introduction  which  occupies 
nearly  the  whole  of  the  first  volume,  passes  in  review  all  the  questions 
relative  to  the  authenticity  of  the  Hippocratic  books,  and  throws  upon  a 
track,  so  well  beaten,  and  apparently  so  sterile,  a  new  light,  and  percep- 
tions, sometimes  profound,  sometimes  ingenious,  which  could  scarcely  have 
been  expected :  so  true  is  it  of  the  facts  of  antiquity,  as  says  the  poet, 

"  On  ne  peut  dans  ce  champ  tellement  moissonner 
Que  les  derniers  venus  n'y  trouvent  a  glaner." 

But  they  are  not  simply  gleanings,  that  the  modern  translator  of 
Hippocrates  has  gathered  in  the  field  of  erudition ;  it  is  a  beautiful  and 
excellent  harvest.  After  the  example  of  his  predecessors,  M.  Littre 
examines  the  catalogue  of  writings  attributed  to  the  father  of  Greek 
Medicine,  and  changes  it  again. 

To  guide  me  in  the  midst  of  this  labyrinth  of  divergent  opinions, 
without  involving  myself  in  researches,  or  dissertations,  which  is  foreign 
to  my  plan,  I  have  adopted  the  following  rule :  I  admit,  as  legitimate, 
those  works  only,  which  the  principal  critics  unanimously  recognize  as 
such ;  and  I  set  aside  the  others,  as  doubtful  or  apocryphal.  This  rule, 
it  seems  to  me,  is  the  best  to  get  at  the  truth  as  nearly  as  possible ;  as 
the  commentators  and  interpreters  have  a  greater  propensity  to  extend 
the  domain  of  their  favorite  author,  than  to  limit  it.  In  accordance 
with  this  rule,  I  now  give  what  appears  to  me  to  be  an  undoubted  list 
of  the  authentic  writings  of  Hippocrates  the  Second : 

The  Prognostic  ; 

Some  Aphorisms  ; 

The  Epidemics,  1st  and  3d  books  ; 


94  PHILOSOPHIC   PERIOD. 

On  the  Regimen  in  Acute  Diseases  ; 

On  Airs,  Waters,  and  Places  ; 

On  Articulations  or  Luxations  ; 

On  Fractures ; 

Mochlic,  or  Treatise  on  Instruments  for  Eeduction. 
This  list  does  not  comprise  the  fourth  part  of  the  entire  Hippocratic 
collection  ;  but,  thus  reduced,  the  portion  ascribed  to  Hippocrates  still 
suffices,  when  we  consider  the  era  in  which  they  were  composed,  to 
justify  the  enthusiasm  of  his  cotemporaries,  and  the  admiration  of 
posterity. 


ART.  II.     THE    HIPPOCRATIC   COLLECTION. 

M.  Littre  establishes,  by  convincing  proofs,  that  the  collection  which 
we  now  possess,  was  not  published  as  a  whole  until  the  foundation  of 
the  great  libraries  of  Alexandria  and  Pergamos.  Until  then,  there 
had  been  only  a  few  books  put  in  circulation  ;  the  major  part  of  these 
writings  had  remained  in  the  hands  of  the  successors  of  Hippocrates, 
who  had  only  communicated  them  to  their  disciples.  This  collection 
includes  a  small  number  of  complete  treatises,  with  a  more  considerable 
number  of  incomplete  ones,  extracts,  fragments,  notes,  and  detached 
thoughts,  the  imperfections  of  which  prove,  for  some  of  them,  at  least, 
that  they  were  not  destined  to  be  made  public.  It  is  composed  of  writ- 
ings of  several  authors  who  succeeded  each  other,  from  Pythagoras  until 
the  Jeath  of  Aristotle,  extending  over  all  the  space  comprehended  by  us 
in  the  philosophic  period. 

United  to  some  fragments  of  Plato  and  Aristotle,  the  Hippocratic 
collection  forms  the  most  ancient  authentic  monument  in  medical  science ; 
it  is  the  first  visible  link  of  the  chain  that  binds  the  doctrines  and  dis- 
coveries of  ancient  Medicine  to  the  doctrines  and  discoveries  of  modern 
Medicine.  Even  on  this  account  alone,  it  merits  at  once  all  our  atten- 
tion, by  the  correctness  of  the  observations,  the  grandeur  of  the  ideas, 
and  the  clear  perceptions  which  adorn  several  portions  of  it. 


§  I.  Anatomy  and  Physiology. 

Neither  Hippocrates  nor  his  descendants  ever  dissected  the  human 
body  ;  the  religious  respect  that  was  had  for  the  dead  in  all  Greece, 
prevented  it.  We,  therefore,  find  in  their  writings  some  generalities, 
merely,  on  the  form,  volume,  and  respective  positions  of  the  principal 
viscera.     Osteology,  only,  is  treated  there  with  sufficient  exactness,  and 


SCHOOLS  OF  THE   ASCLEPIAD^.  95 

this  fact  is  explained  by  a  tradition,  which  says  that  the  Asclepiadae, 
of  Cos,  kept  in  their  school  a  human  skeleton,  for  the  instruction  of 
their  pupils.  They  had  been  able  moreover  to  acquire  some  knowledge 
on  the  conformation  of  the  internal  parts,  in  examining  the  entrails  of 
victims,  in  the  case  of  the  wounded,  whose  splanchnic  cavities  were 
opened,  and  in  dissecting  animals.  Such  are,  according  to  the  opinions 
of  nearly  all  historiographers  and  critics,  the  sources  whence  the  members 
of  the  Hippocratic  family  obtained  their  anatomical  knowledge.  Never- 
theless, I  must  say,  that  the  author  of  the  History  of  Anatomy,  whom 
I  have  already  cited,  denies  that  Hippocrates  ever  dissected  animals,  or 
even  had  in  his  possession  a  veritable  skeleton.  Be  this  as  it  may,  the 
following  are  the  books  of  the  collection  in  which  are  found  the  most  of 
the  anatomical  details :  Eegions  in  man  ;  Wounds  of  the  Head  ;  The 
Mochlic  ;  The  Heart ;  The  Glands  ;  The  Nature  of  Bones ;  A  Frag- 
ment on  the  Dissection  of  the  Body. 

The  prejudice  which  forbade  the  touch  of  the  human  corpse,  did  not 
begin  to  abate  until  toward  the  close  of  the  philosophic  period,  at  which 
time  the  family  of  Hippocrates  appears  to  be  extinct,  the  name  of  any 
his  decendants  no  more  appearing  in  the  history  of  Medicine. 

Physiology,  as  we  conceive  it  in  our  day,  that  is,  that  branch  of  the 
science  of  man  which  is  devoted  to  the  description  of  the  functions  of 
each  organic  apparatus,  can  not  make  one  step  without  being  guided  by 
the  light  of  anatomy.  It  is,  therefore,  not  astonishing  that  we  en- 
counter scarcely  any  traces  of  it  in  the  Hippocratic  writings.  We 
read  in  them  that  the  glands  are  spongy  viscera,  destined  to  secrete 
humidity  from  the  surrounding  parts,  and  that  the  brain,  the  largest  of 
the  glands,  attracts  the  vapors  of  all  the  interior  of  the  body.  The 
muscles,  which  they  called  flesh,  were  for  the  purpose  of  covering  the 
bones ;  the  nerves,  the  tendons,  the  ligaments,  the  membranes,  are  all 
represented  as  analogous  organs,  concurring  in  the  same  manner  to  the 
production  of  motion.  The  arteries  and  veins  are  generally  confounded, 
or  if  they  are  distinguished,  it  is  only  on  the  supposition  that  the  former 
contained  air  and  the  latter  blood.  Respiration  was  supposed  to 
moderate  the  heat  of  the  lungs,  and  especially  of  the  heart. 

But  if  the  physiologists  of  those  times  neglected  the  special  study  of 
the  organic  functions,  in  lieu  of  it,  they  gave  themselves  up  to  transcen- 
dental speculations  on  the  nature  and  seat  of  the  principle  of  life. 
Some  placed  the  source  of  life  in  moisture,  others  in  fire,  others  in  the 
union  of  two  or  four  elements,  etc.  Each  one  endeavored  to  sustain 
his  hypothesis  by  arguments  more  or  less  specious,  and  aspired  to  the 
glory  of  going  back  to  first  principles.  Intermediate  knowledge,  or  the 
study  of  details,  was  considered  as  of  but  little  value.     Such  was  the 


96  PHILOSOPHIC   PERIOD. 

general  direction  given  to  scientific  researches  bj  the  philosophers. 
Many  books  of  the  collection  contain  speculations  of  this  kind,  as  we 
shall  see  when  we  come  to  expose  their  theories. 


§  II.  Hygiene. 

We  remarked,  in  speaking  of  Medicine  among  the  Hebrews,  with 
what  care  Moses  had  regulated  everything  that  concerned  health.  The 
Asclepiada?,  who,  like  him,  owed  their  first  scientific  instructions  to 
the  Egyptian  priests,  gave  special  attention,  also,  to  hygiene.  Their 
writings  on  this  branch  of  the  art  have  in  general  all  the  completeness 
that  could  be  attained  from  the  lights  of  that  era.  They  are,  first,  a 
treatise  on  Airs,  Waters,  and  Places,  a  work  written  with  great  firm- 
ness, and  ornamented  with  all  the  pomp  of  style.  The  author  there  ex- 
plains methodically,  and  on  the  authorit}'  of  his  experience,  the  influence 
of  climates,  seasons,  and  various  topographical  circumstances,  on  the 
constitution  of  man.  The  work  has  been  reproached  for  its  superficial 
treatment  of  the  subject ;  but  it  must  not  be  forgotten  that  experimental 
physics  was  not  yet  born,  and  that  without  it  such  a  subject  could  not 
be  treated  in  a  profound  manner.  We  have  already  spoken  of  the 
book  at  the  commencement  of  our  account  of  the  present  period, 
and  it  may  be  inferred  from  what  was  there  said,  that  no  other  book  of 
the  period  contains  views  of  higher  philosophic  import.  I  shall  add,  in 
support  of  my  assertion,  but  this  single  remark :  it  contains  the  germ  of 
two  modern  productions,  justly  regarded  as  chefs-d'ceuvre — the  "  Spirit 
of  Laws,"  by  Montesquieu,  and  the  "  Relation  of  the  Moral  and  Phy- 
sical Man,"  by  Cabanis." 

2.  A  treatise  on  Eegimen,  divided  into  three  books ;  a  well-conceived 
and  well-executed  composition,  notwithstanding  some  digressions  and 
strange  associations  that  impair  the  first  part.  The  author  considered 
man  as  formed  of  two  principles,  fire  and  water,  the  just  balance  of 
which  constituted  health.  The  first  book  is  entirely  devoted  to  the  de- 
velopment of  that  theory :  in  the  second  he  examines  the  various  hygienic 
modifiers,  relative  to  their  faculty  for  causing  dryness  or  moisture  ; 
finally,  in  the  third  book  he  regulates  the  use  which  is  to  be  made  of 
these  modifiers,  as  regards  the  social  position  and  the  occupation  of 
persons,  the  seasons  of  the  year,  and  especially  in  regard  to  the  bulk 
and  fullness  of  the  body.     Already  we  see  appear  the  dichotomy,  to 

^  See  his  Lettre  Bur  les  Causes  Premieres. 


SCHOOLS   OF  THE   ASCLEPIAD^.  97 

which  so  many  physiologists   have  since   endeavored,   under  various 
names,  to  refer  all  the  modifications  of  the  animal  economy. 

3.  The  small  treatise  on  Salubrious  Diet,  summarily  abridged  from 
the  preceding  work,  and  free  from  all  physiological  dissertation :  it  is, 
however,  obnoxious  to  the  single  reproach  of  being  too  succinct.  The 
author  mentions  in  it  the  custom  of  certain  persons  taking  one  or  two 
vomits  a  month,  as  being  an  ordinary  hygienic  proceeding  of  his  time. 
"  He  who  is  in  the  habit  of  vomiting  himself  twice  a  month,"  he  re- 
marks, "will  find  more  advantage  in  doing  so  on  two  successive  days 
than  once  every  two  weeks." 


§  III.     Pathology  and  Therapeutics. 

We  have  given  a  glance  of  the  views  which  the  Asclepiadse  had  acquired 
on  the  structure  and  functions  of  different  parts  of  the  human  body,  as 
well  as  of  means  employed  to  maintain  their  integrity  of  function.  We 
now  proceed  to  say  something  on  the  ideas  they  had  touching  the  disor- 
ders of  these  functions,  and  the  means  employed  to  restore  them  to  their 
normal  state.  These  last  two  branches  of  medicine  are  designated  by 
the  names  of  Pathology  and  Therapeutics,  each  of  them  to  be  subdivided 
in  different  ways,  according  to  the  views  of  authors  and  the  extent  of 
the  knowledge  of  their  age. 

One  of  the  most  ancient  divisions  of  pathology  and  therapeutics  con- 
sisted in  dividing  diseases  and  modes  of  treatment  into  two  classes,  one 
called  internal  or  medical,  the  other,  external  or  chirurgical.  We  shall 
preserve  this  distribution ;  not  that  it  is  so  philosophic,  but  because  the 
greater  part  of  writers  whose  labors  we  must  examine  have  followed  it, 
and  because  it  yet  exists  in  science,  notwithstanding  its  evident  defects. 

I  will  make  only  one  prefatory  remark,  the  truth  of  which  will  stand 
out  more  and  more  in  the  course  of  this  history ;  it  is,  that  a  scientific 
classification  is  nothing  else  than  an  artificial  arrangement  of  the  facts 
and  ideas  that  constitute  a  science.  Now,  as  new  facts  and  ideas  were 
added  each  day  by  the  ancients,  it  follows  that  the  same  arrangement 
would  not  always  be  suitable.  For  example,  a  pathological  classifica- 
tion which  may  have  been  satisfactory  in  the  time  of  Hippocrates,  would 
to-day  be  very  defective.  The  Nosology  of  Sauvages,  so  celebrated  in 
the  last  century,  has  already  become  superannuated.  To  pretend  to 
trace  a  systematic  and  an  immovable  list  which  should  include  all  the 
ideas  and  discoveries  of  future  generations,  would  in  some  sort  be  like 
digging  a  pit,  out  of  which  the  genius  of  man  could  never  emerge. 
Some  have  attempted  this,  but  no  one  has  ever  succeeded.     The  merit 


98  PHILOSOPHIC   PERIOD. 

of  a  methodic  repartition  consists,  as  I  think,  in  embracing  as  far  as 
possible  the  totality  of  the  materials  of  which  science  is  composed  at  a 
given  period,  and  presenting  them  in  lucid  order,  so  as  to  aid  the  mem- 
ory and  the  judgment;  but  it  is  plain  that  such  a  plan  must  vary  with 
the  different  phases  of  science. 

During  the  philosophic  period  the  animal  economy  was  considered  as 
a  whole,  nearly  indivisible ;  the  morbid  phenomena  being  regarded  as 
the  expression  of  a  general  derangement  of  the  organism,  rather  than  as 
the  index  of  the  derangement  of  any  part.  Consequently,  the  symptoms, 
their  progress,  gravity,  and  indications,  were  often  studied  without  re- 
gard to  any  particular  species  of  disease.  It  was  said,  for  example, 
"  The  physician  should  find  his  patient  lying  on  the  right  or  left  side, 
having  the  arms,  the  neck,  and  the  legs  a  little  flexed,  and  the  entire 
body  moist ;  for  so  the  greater  part  of  men  in  good  health  repose  on  their 
beds,  and  the  most  favorable  position  in  a  patient  is  that  which  is  as- 
sumed in  a  state  of  health.  To  lie  on  the  back,  with  the  arms  and  legs 
extended,  is  less  favorable.  The  tendency  to  sink  in  the  bed  and  slide 
down  to  the  foot  is  still  more  unfavorable."  " 

This  study  of  symptoms,  considered  in  a  general  and  abstract  manner 
was  pushed  very  far  in  the  school  of  Cos.  It  gave  birth  to  a  branch  of 
Pathology  which  is  termed  Semeiotics,  which  we  will  now  first  consider. 


§  IV.     Semeiotics. 

Semeiotics  occupies  a  very  considerable  place  in  the  medical  works  of 
the  Asclepiadae.  Two  of  the  most  complete  and  best  achieved  treatises 
of  the  collection — that  on  Prognostics,  and  the  second  book  on  Predictions, 
or  Prorrhetics — are  devoted  to  this  branch  of  Pathology,  Beside,  the 
first  book  on  Predictions  and  Coan  Prenotions,  a  species  of  treatises 
believed  to  belong  anterior  to  Hippocrates,  as  well  as  the  book  on  Dreams, 
which  is  appended  to  the  treatise  on  Eegimen,  relate  entirely  to  the  same 
subject.  Now,  all  these  portions  united,  form  more  than  the  eighth 
part  of  the  entire  collection,  without  counting  a  great  number  of  Semei- 
otic  sentences  scattered  in  other  works,  and  especially  among  the  Apho- 
risms. 

Hippocrates,  at  the  beginning  of  his  work  on  Prognosis,  gives  us  a 
very  precise  idea  of  the  sense  that  was  formerly  attached  to  this  word, 
while,  at  the  same  time,  he  appreciates,  in  the  highest  manner,  the 
importance  of  this  branch  of  Pathology.     "  The  best  physician,"  he 

*  Prognostics. 


SCHOOLS   OF   THE   ASCLEPIAD^.  99 

says,  "  is  the  one  who  is  able  to  establish  a  prognosis ;  penetrating  and 
exposing  first  of  all.  at  the  bed-side,  the  present,  the  past,  and  the  future 
of  his  patients,  and  adding  what  they  omit  in  their  statements ;  he  will 
gain  their  confidence ;  and  being  convinced  of  the  superiority  of  his 
knowledge,  they  will  not  hesitate  to  commit  themse'  /es  entirely  into  his 
hands.  He  can  treat,  also,  so  much  better  their  present  condition,  in 
proportion  as  he  shall  be  able  from  it  to  foresee  the  future.  To  restore 
to  health  all  the  sick  is  impossible ;  and  although  this  would  be  better 
than  being  able  to. predict  the  successive  progress  of  symptoms,  yet,  since 
men  must  die,  some,  succumbing  before  calling  a  physician,  are  carried 
off  by  the  violence  of  the  disease ;  others,  immediately  after  having  sum- 
moned one,  surviving  only  a  day  or  so,  expiring  before  the  physician  has 
been  able  to  combat  by  his  art,  each  of  the  accidents ;  nevertheless,  it  is 
important  to  understand  the  nature  of  such  affections,  and  how  much 
they  exceed  the  constitutional  forces,  and,  at  the  same  time,  discern  if 
there  be  any  thing  to  divine  in  the  disease ;  this  is  the  great  thing  yet 
to  learn."  In  this  way  the  physician  will  be  justly  admired,  and  will 
practice  his  art  skillfully ;  indeed,  those  who  can  be  cured,  he  will  be 
much  more  capable  of  preserving  from  peril,  in  advising  them,  long 
before-hand,  against  certain  casualties ;  and,  on  the  other  hand,  in  fore- 
seeing and  pointing  out  those  who  must  perish,  and  those  who  will 
recover,  he  will  exempt  himself  from  all  blame.* 

We  perceive  in  this  passage,  that  the  word  prognostics  had  a  much  more 
extended  signification  among  the  ancients,  than  it  has  among  moderns — 
that  it  includes,  at  the  same  time,  prognosis  and  diagnosis.  The  second 
paragraph  of  the  same  book,  shows  in  what  way  the  first  Hippocratists 
established  their  prognosis,  and  gives  an  idea  of  the  extreme  difference 
that  exists  between  the  Medicine  of  their  times,  and  that  of  ours.  "  In 
acute  diseases,"  says  the  author,  "the  physician  must  make  the  follow- 
ing observations :  first,  let  him  examine  the  countenance  of  the  patient, 
and  see  if  the  physiognomy  is  similar  to  that  of  men  in  health,  but 
above  all,  if  it  is  like  itself.  Such  an  appearance  will  be  most  favor- 
able, but  the  danger  will  be  greatest  in  proportion  as  the  expression  is 
unnatural.  The  features  have  attained  the  last  degree  of  alteration, 
when  the  nose  becomes  pointed,  the  eyes  sunken,  the  temples  flattened, 
the  ears  cold  and  contracted,  their  lobes  shrunken ;  the  skin  of  the  fore- 
head dry,  tense,  and  parched ;  the  skin  of  the  entire  face  of  a  yellow, 
dark  livid,  or  leaden  hue.  If  from  the  beginning  of  a  disease  the 
patient's  countenance  presents  these  traits,  and  if  other  signs  do  not 
furnish  sufficient  explanation,  the  patient  should  be  asked  if  he  has  lost 

'*  Prognostics,  §  1. 


100  PHILOSOPHIC   PERIOD. 

much  rest,  or  has  a  severe  diarrhea,  or  is  suffering  from  hunger.  An 
affirmative  response  on  either  of  these  points,  would  cause  the  peril  to 
be  regarded  as  less  imminent ;  such  a  morbid  condition,  resulting  from 
any  of  the  causes  above  mentioned,  may  be  arrested  in  the  course  of 
twenty-four  hours ;  but  if  the  patient  does  not  communicate  any  of  these 
causes,  and  if  the  affliction  does  not  cease  in  the  interval  above-men- 
tioned, it  may  be  predicted  that  death  is  not  far  distant.""  How  much 
time  and  observation  were  necessary  to  unite  thus  in  a  single  tableau  the 
evidences  of  decomposition  in  the  human  body  at  the  moment  of  approach- 
ing death  ;  to  associate  this  frightful  train  of  symptoms,  sometimes  with 
a  slight  affection,  that  may  be  cured  in  a  day,  and  again,  with  a  des- 
perate state,  whose  fatal  termination  can  not  be  arrested !  Kemark,  that 
on  these  occasions  the  physician  forms  his  judgment,  and  makes  his 
prognosis,  without  occupying  himself  with  the  interior  organs,  which 
require  much  more  sagacity,  and  would  be,  however  much  attention  he 
might  give  them,  a  source  of  frequent  error.  To-day,  a  physician,  in 
presence  of  such  an  assemblage  of  symptoms,  would  seek  and  find  their 
cause  in  some  visceral  lesion ;  but  this  was  not  possible  in  the  age  of 
Hippocrates,  and  for  a  long  time  after  him.  Deprived  of  the  light  of 
post-mortem  examinations,  the  physician  of  that  time  was  forced  to 
make  his  observations  on  superficial  phenomena,  and  deduce  his  prog- 
nosis and  treatment  from  them. 

He  who  is  in  the  habit  of  seeing  patients,  and  knows  by  experience 
the  inconceivable  variety,  and  inconstancy  of  morbid  symptoms,  can 
alone  appreciate  the  time,  labor  and  patience  it  required  to  deduce  some 
general  propositions  from  the  observation  of  phenomena ;  to  trace,  in  a 
word,  those  rules  of  Semeiotics  which  ancient  Medicine  has  transmitted 
to  us,  and  some  of  which  still  preserve  all  their  original  value.  If  more 
perfect  and  more  varied  means  of  investigation  allow  us  now  to  carry 
our  observations  still  further,  we  must  at  least  admire  the  perspicuity 
of  the  ancients,  who,  in  many  cases,  were  able  to  foresee  the  future 
events  in  diseases,  with  as  much  certainty  as  ourselves. 

Observe  also  that  the  greater  part  of  the  rules  of  Semeiotics  are 
announced  in  an  absolute  manner,  and  in  the  form  of  aphorisms,  which 
indicate  the  way  in  which  they  were  established.  They  must  have  pro- 
ceeded in  nearly  the  following  manner :  when  the  identical  or  analo- 
gous symptoms  were  presented  a  certain  number  of  times  in  the 
same  order,  the  fact  of  their  habitual  succession  was  established  by 
a  general  proposition,  often  without  exception,  because  experience  had 
not  yet  made  these  known  to  them.     But  afterwards,  in  proportion  as 

"  Prognostics.  §  2. 


II 


SCHOOLS   OF  THE    ASCLEPIAD^.  101 

such  exceptions  were  observed,  they  were  noted,  and  new  aphorisms 
drawn  from  them,  which  sometimes  merely  limited  the  first,  or  even 
contradicted  them.  At  length  the  exceptions  to  the  first  observa- 
tions became  so  multiplied  that  those  axioms  lost  much  of  their 
value.  The  authors  who  adopted  at  a  later  period  that  style  of  writing, 
were  less  aflBrmative  and  less  absolute  in  their  sentences,  and  therefore 
inspired  less  confidence.  This  change  is  already  seen  to  take  place 
between  the  writings  of  the  treatise  on  Prognosis  and  the  second  book 
of  Predictions.  The  author  of  the  latter,  whoever  he  was,  exhibits 
less  self-confidence,  and  is  less  positive  than  his  predecessor.  He  com- 
mences even  by  cautioning  the  reader  against  the  marvelousness  of 
certain  predictions,  and  cites  for  examples  those  that  were  attributed 
to  the  directors  of  the  gymnasire :  "As  for  me,"  he  adds,  "I  can  not 
divine,  but  I  will  describe  the  symptoms  that  will  enable  you  to  judge 
which  of  your  patients  will  recover  and  which  will  succumb,  and 
whether  they  will  recover  soon,  or  be  long  sick."  " 

It  appears  from  some  passages  in  the  same  book,  and  from  a  frag- 
ment on  dreams,  which  is  a  part  of  the  Hippocratic  collection,  that  it 
was  the  custom  of  physicians  of  that  time,  to  announce  the  probable 
issue  of  the  disease  at  the  first  or  second  visit.  This  custom  still  pre- 
vails in  China.  It  likewise  prevails  in  Turkey,  as  is  attested  by  my 
respectable  friend,  M.  le  Doctor  Brayer,  who  relates  on  this  subject  a 
curious  anecdote,  in  which  he  was  in  some  sort  obliged  to  play  the  part 
of  a  diviner. f  Such  an  usage  indicates  the  infancy  of  art,  and  can  only 
exist  as  the  effect  of  ignorance  and  superstition.  It  supposes  that  a 
physician  is  consulted  as  an  oracle  —  as  a  man  endowed  with  super- 
human science,  and  not  as  a  simple  mortal,  who  by  reason  of  study  and 
observation  has  attained  the  fixed  impression  in  his  mind  of  the  natural 
progress  of  a  given  number  of  diseases,  and  groups  certain  character- 
istics, by  means  of  which  he  can  in  some  cases  announce  their  probable 
issue.  Hippocrates  blames  loudly  these  physicians,  who  abandoning 
the  route  of  truth  and  rectitude,  assume  the  position  of  thaumaturgs 
before  their  patients,  constructing  their  replies  in  a  vague  and  ambig- 
uous manner,  so  that  they  may  be  adapted  to  the  most  diverse  develop- 
ments ;  in  short,  the  usage  of  all  such  artifices  as  are  now  employed  by 
sorcerers,  card-drawers,  and  somnambulists,  to  deceive  those  men  that 
disease,  ignorance,  or  love  of  the  marvellous  renders,  and  always  will 
render,  easy  to  be  imposed  upon. 

'^  Second  Book  of  Predictions,  by  Gardeil. 
t  Ibid. 


102  PHILOSOPHIC    PERIOD. 

§  V.  Internal  Nosography; 

Nosography  is  the  eye  of  therapeutics.  In  proportion  as  the  first  is 
lucid,  methodic,  and  complete,  the  second  is  sure  and  rational.  The 
possession  of  the  most  efficacious  curative  agents  is  of  no  avail  to  us  if 
•we  can  not  distinguish  the  cases  in  which  their  use  is  advantageous, 
from  those  in  which  they  would  be  injurious.  In  fact  the  more  the 
means  that  the  therapeutist  dispensers  have  of  power  and  energy,  the 
more  they  become  dangerous  in  the  hands  of  the  ignorant.  That  which 
distinguishes  the  sage  and  enlightened  practitioner  from  the  blind  and 
headlong  routinist,  is  the  knowledge  of  indications.  Now  this  know- 
ledge is  only  acquired  by  the  comparison  of  the  morbid  phenomena 
that  are  before  him,  with  those  that  he  has  before  observed,  and  with 
the  most  faithful  nosological  descriptions  of  others. 

In  many  passages  of  the  Hippocratic  works,  diseases  are  termed 
sporadic,  epidemic,  and  endemic,  a  useful  and  well  founded  distinction, 
of  which  the  practitioner  should  never  lose  sight  while  the  same  affec- 
tion changes  in  gravity  and  requires  different  treatment,  accordingly  as 
it  exists  under  one  or  other  of  the  above  forms. 

The  same  writers  also  divide  diseases  into  acute  and  chronic,  but 
they  do  not  seem  to  attach  a  near  and  precise  idea  to  this  separation  — 
they  only  indicate  it,  and  in  their  pathological  works  they  mingle 
indifferently,  and  confound  these  two  classes  of  morbid  affections  ;  in 
general  they  observe  no  order.  In  one  of  them  alone  they  are  distin- 
guished from  each  other  by  a  more  methodic  arrangement,  and  that  is  the 
work  on  Affections,  a  summary  abridgment  of  nosography,  the  most  com- 
plete of  the  collection.  In  it  the  diseases  are  classified  according  to 
their  localities,  beginning  at  the  head  and  going  down  to  the  feet. 
Thus  phrenitis,  that  was  supposed  to  be  a  disease  of  the  diaphragm, 
is  described  immediately  after  pneumonia ;  and  what  is  remarkable, 
fevers  follow  phrenitis,  because  supposed  to  have  their  seat  in  the 
superior  viscera  of  the  abdomen. 

The  following  is  the  list  of  the  Hippocratic  books  devoted  wholly  or 
in  part  to  internal  nosology  : 

1.  The  treatise  on  the  Regimen  in  acute  diseases,,  from  the  29th  to 

the  44th  paragraph,  inclusive. 

2.  The  treatise  on  the  Regions  in  man,  from  the  16th  paragraph  to 

the  end. 

3.  A  small   monograph  on  Epilepsy,  which  was  called  the  sacred 

disease. 

4.  A  treatise  on  Diseases,  in  four  volumes. 


SCHOOLS   OF  THE  ASCLEPIAD^.  103 

5.  A  treatise  on  Affections. 

6.  On  Internal  Affections. 

7.  A  fragment  on  Diseases  of  Girls,  relating  particularly  to  histeria. 

8.  A  book  on  the  Nature  of  Woman. 

9.  A  treatise  on  Diseases  of  Women,  in  two  volumes. 

10.  A  monograph  on  Sterility. 

All  these  books  and  fragments  united,  are  far  from  constituting  a 
complete  nosography  of  internal  diseases.  In  the  first  pla:;e  the  greater 
part  of  chronic  affections  are  only  designated  by  their  names.  Some 
are  not  even  named,  and  a  very  small  number  are  described.  The 
omission  of  all  that  class  of  diseases,  so  important,  is  owing  to  the  fact 
that  they  were  generally  regarded  as  inconveniences  which  did  not 
merit  the  attention  of  physicians.  We  have  already  quoted  and 
refuted  the  opinion  of  Plato,  who  blames  Herodicus  for  striving  to  pro- 
long the  existence  of  valetudinarians  by  the  aid  of  gymnastics.  Here 
is  a  passage  from  another  author,  cotemporaneous  with  that  philosopher, 
who  agrees  very  nearly  with  him :  "  Leprosy,  pruritis,  teter,  white 
spots  on  the  skin,  baldness,  etc  ,  it  is  said,  proceed  from  the  pituite  ; 
on  this  account  remedies  are  employed  to  evacuate  this  humor  ;  but 
they  are  rather  deformities  than  diseases." 

In  the  second  place,  though  the  attention  of  the  Asclepiadge  was  prin- 
cipally directed  to  acute  diseases,  the  descriptions  which  they  have 
transmitted  to  us,  are,  for  the  most  part,  so  defective,  that  it  would  be 
difficult,  if  not  impossible,  to  report  a  single  one  of  them  that  offers  a 
tableau  at  all  complete  or  well  arranged,  of  any  morbid  species  what- 
ever. 

I  conclude  from  this,  that  the  remains  of  medical  antiquity  have  now 
little  interest  in  a  didactic  point  of  view  ;  but  though  they  are  com- 
pletely sterile  for  the  student  and  young  practitioner,  they  will  always 
interest,  to  the  last  degree,  the  erudite  man  and  the  philosopher,  to 
whom  these  delus  are  one,  as  stakes  that  indicate  the  route  followed  in 
antiquity  by  science,  and  serving  to  measure  the  stages  through  which 
she  has  passed. 

On  this  account,  my  readers  will  not  be  displeased,  J  presume,  to  find 
here  two  descriptions  of  diseases,  chosen  from  amongst  those  which  have 
appeared  the  best  defined  in  the  Hippocratic  collection. 

ON    PERIPNEUMONIA." 

"  Peripneumonia  shows  itself  in  the  following  manner  :  a  great  fever  is 
developed ;  the  respiration  is  hot  and  frequent ;  the  patient  does  not 

''  Traite  dos  Maladies,  liv.  3e,  §  17,  trad,  de  Gardeil. 


104  PHILOSOPHIC   PERIOD. 

know  how  to  contain  himself ;  he  is  feeble  and  totters.  The  pain  is  felt 
at  the  shoulders,  above  and  in  front  of  the  chest,  as  far  as  the  breasts. 
He  grows  worse — sometimes  delirium  supervenes.  There  is  a  species 
of  peripneumonia  where  the  pain  is  only  felt  when  the  patient  begins  to 
cough.  These  are  more  dangerous  and  longer  continued.  At  first  the 
expectoration  is  small  and  frothy ;  the  tongue  is  yellow,  and  becomes 
darker.  When  it  is  black  from  the  commencement,  the  disease  is  more 
rapidly  developed ;  it  is  slower  in  its  progress  when  the  blackening  of 
the  tongue  comes  on  later ;  afterwards  it  becomes  rough  and  cracks,  the 
finger  adhering  to  it  when  applied.  The  changes  in  the  state  of  the 
tongue  announce  those  of  the  disease,  the  same  as  in  pleurisy.  Peri- 
pneumonia continues  at  least  fourteen  days,  or  twenty-one  at  farthest. 

"  During  this  time  the  cough  is  severe,  and  the  lungs  are  depleted  by 
the  cough.  At  first,  the  expectoration  is  frothy  and  copious ;  about  the 
seventh  or  eighth  day,  when  the  fever  is  in  full  force,  if  the  peripneu- 
monia is  moist,  it  becomes  thicker ;  unless  it  shall  become  on  the 
seventeenth  day  a  green  color,  it  will  be  slightly  sanguineus.  From 
the  twelfth  to  the  fourteenth  day,  it  will  be  abundant,  and  of  a  puru- 
lent character.  Such  is  the  state  amongst  those  who  have  a  humid 
temperament  and  constitution,  and  in  whom  the  disease  is  severe ;  but 
those  in  whom  the  temperament  and  character  of  the  disease  are  dry, 
the  attack  is  less  dangerous. 

"  If  then,  on  the  fourteenth  day,  the  cough  is  not  accompanied  by  puru- 
lent expectoration,  and  the  lung  becomes  dry,  the  patient  is  cured.  In 
an  opposite  case,  give  attention  on  the  eighteenth  or  twenty-first  day,  to 
see  if  the  expectoration  is  abating ;  if  it  is  not,  ask  the  patient  if  it  is 
sweetish.  If  he  says  yes,  you  may  know  that  the  lung  is  suppurating — 
this  condition  is  determined.  It  may  last  a  year  unless  all  the  pus  is 
cast  off  in  forty  days.  "When  the  patient  shall  respond  that  the  expec- 
toration has  a  very  bad  taste,  his  condition  is  mortal. 

"  One  may  thus  know  what  to  expect  from  the  first ;  for  when  the  pa- 
tient expectorates  all  the  bad  pus  in  twenty-two  days,  and  no  new  injury 
is  developed,  he  will  recover.  In  the  other  case,  he  will  die.  The  first 
of  these  two  species  of  peripneumonia  leaves  no  vestige  of  itself  in  the 
lungs.  It  is  essential  to  be  aware  of  all  the  sufi'erings  the  patient  real- 
izes, and  what  are  the  therapeutical  resources  to  combat  them.  When 
the  symptoms  are  moderate,  success  is  certain ;  the  peripneumonia  is 
not  mortal  in  its  nature,  and  it  will  be  mild.  I  will  now  give  the 
treatment." 


SCHOOLS   OP  THE   ASCLEPIAD^.  105 


PLEURISY. ■•• 

When  an  individual  is  attacked  with  pleurisy,  the  following  are  the 
symptoms :  pain  in  the  side,  with  fever,  shiverings  and  frequent  respi- 
ration ;  there  is  cough,  and  difficulty  in  breathing  while  lying  down. 
The  expectoration  is  bilious,  and  of  the  color  of  the  bark  of  the  pome- 
granate when  there  is  no  lesion  in  the  lungs ;  if  such  exists,  it  will  be 
sanguineous  ;  when  it  is  bilious  and.  there  is  no  lesion,  the  attack  is 
milder.  In  an  opposite  case,  it  is  graver,  and  even  mortal  if  hiccup  su- 
pervenes ;  the  cough  brings  up  saliva  and  clots  of  black  blood ;  the 
patient  dies  on  the  seventh  day.  When  he  survives  to  the  tenth  day, 
the  pleurisy  is  healed ;  but  if  it  goes  on  to  the  twentieth,  suppuration 
is  established,  and  pus  is  expectorated,  which  is  finally  vomited,  and  the 
cure  is  rendered  difficult. 

"  There  are  dry  pleurisies  without  expectoration,  which  are  very 
grave.  The  crises  occur  as  in  humid  pleurisies,  but  there  is  more  need 
of  drinks.  The  bilious  and  sanguineous  crises  take  place  at  the  ninth 
and  eleventh  days.  It  is  cured  more  easily  when  from  the  commence- 
ment the  pain  is  moderate,  and  becomes  acute  about  the  fifth  or  sixth 
day ;  the  disease  continues  then  until  the  twelfth  ;  if  the  patient  pass  that 
be  will  get  well.  When  the  suffering  has  been  moderate  from  the  be- 
ginning, but  violent  from  the  seventh  to  the  eighth  day,  the  crisis  is 
not  determined  until  the  fourteenth,  after  which  the  danger  is  passed. 

"  Pleurisy  of  the  back  differs  from  the  preceding,  in  its  pain  seeming 
to  be  more  like  that  of  a  wound.  The  patient  groans,  and  the  respira- 
tion is  frequent.  Very  soon  expectoration  occurs  in  small  quantities ; 
general  prostration  follows.  On  the  third  or  fourth  day  a  bloody  urine 
is  voided.  Death  occurs  commonly  about  the  fifth  or  seventh  day. 
Those  who  pass  these  days  may  recover.  The  disease  after  this,  becomes 
more  tractable.  It  is  necessar'y,  however,  to  be  watchful  till  the  four- 
teenth day  ;  beyond  that,  the  patient  is  safe. 

"  Some  pleuretics  expectorate  pure  phlegm  only,  whilst  their  urine  is 
sanguineous,  resembling  the  fluids  of  roast  meats  :  they  feel  very  acute 
pains  in  the  front  of  the  chest  and  groins.  If,  however,  they  pass  the 
seventh  day,  they  will  get  well. 

"  When  in  pleurisy  there  supervenes  redness  on  the  back,  with  heat 
-at  the  shoulders,  a  feeling  of  weight  and  uneasiness  in  the  abdomen, 
with  green  and  fetid  discharges,  the  patients  will  die  on  the  twentieth 
day  in  consequence  of  this  evacuation,  but  if  they  live  beyond  the 
twentieth,  they  will  get  well." 


^'Traite  des  Maladies,  Vol.  Ill,  §  18,  19,  20,  trad,  de  Gardeil 

7 


106  PHILOSOPHIC   PERIOD. 

Such  descriptions,  as  already  remarked  at  the  commencement  of  this 
chapter,  have  no  utility  for  a  reader  unacquainted  with  medical  studies, 
or  for  a  beginner  ;  but  they  are  valuable  as  historic  record,  to  establish 
the  state  of  the  Science  at  a  very  remote  epoch,  of  which  we  have  but  few 
remains.  The  experienced  practitioner  will  discover  in  them  many 
interesting  features  of  the  diseases  which  he  has  himself  observed,  atid 
which  prove  to  a  certain  point,  the  exactness  of  the  tableaux. 


§  VI.     Therapeutics. 

The  physicians  of  the  two  preceding  periods  have  not  emitted  any  gene- 
ral law  in  Therapeutics ;  they  regulated  their  practice  instinctively  upon 
the  following  plan :  when  a  remedy  has  cured  any  disease,  it  should  cure 
all  other  identical  diseases.  This  axiom,  incontestably  true  in  itself,  is 
but  a  fragment  of  one  much  more  general,  which  embraces  the  whole 
philosophy  of  causes,  and  may  be  expressed  thus:  the  same  agents, 
placed  in  the  same  identical  circumstances,  will  always  produce  the 
same  effects.  But  a  proposition  so  universal,  which  appertains  to  medi- 
cine no  more  than  to  the  other  sciences,  and  which  takes  no  account  of 
the  internal  action  of  medicines,  appeared  too  superficial  to  philosophical 
physicians,  and  too  vague  to  practitioners  who  desired  a  rule  less  com- 
mon ;  in  short,  one  more  directly  related  to  the  healing  art.  Conse- 
quently, both  parties  sought  another  fundamental  principle,  and  the 
following  is  the  result  of  their  speculations  on  this  subject :  it  was  held 
that  there  always  exists  a  species  of  antagonism  between  the  cause  of 
the  morbid  phenomena  and  the  active  properties  of  the  remedies  that 
cured  them ;  or  rather,  between  the  pathological  modification  of  the  or- 
ganism and  the  curative  impulse  given  to  the  economy  by  the  treatment. 
This  law  was  expressed  by  the  following  aphorism :  contraria  contrariis 
curantiir. 

The  greater  number  of  medical  writers  adopted  this  principle,  and 
endeavored  to  establish  the  practice  of  medicine  upon  it.  Now,  two 
things  were  necessary  for  that :  first,  to  discover  the  essential  cause  of 
each  disease,  or  the  primitive  lesion  that  constitutes  each  morbid  spe- 
cies ;  secondly,  to  determine  the  mode  of  action  and  the  degree  of  energy 
of  therapeutic  agents,  so  that  the  practitioner  may  choose  from  among 
them,  those  which  were  more  directly  contrary  to  the  affection  he  is 
called  upon  to  combat.  The  course  of  this  history  will  show  us  the  re- 
sults of  the  efforts  made  at  different  epochs  to  attain  this  double  end, 
and  we  shall  have  occasion  more  than  once  to  discuss  the  validity  of 
hypcsnantiosis,  or  the  doctrine  of  contraries. 


» 


SCHOOLS   OF  THE    ASCLEPIAD^.  107 

At  present  it  will  suffice  to  say,  that  from  its  commencement  this 
principle  has  not  been  universally  adopted.  Thus,  the  author  of  the 
book  entitled  "Ancient  Medicine,"  one  of  the  most  philosophic  of  the 
collection,  devotes  several  paragraphs  to  the  refutation  of  this  axiom. 
And  we  read  in  the  treatise  on  the  liegions  of  JIan,  that  diseases  are 
sometimes  cured  by  contraries,  sometimes  by  similars,  and,  finally,  some- 
times by  remedies  which  have  neither  similitude  nor  opposition.-' 

We  shall  conclude  this  chapter  by  giving  examples  of  the  manner  in 
which  the  practitioners  of  those  times  applied  the  general  principles  of 
Therapeutics  to  the  treatment  of  particular  diseases.  The  following 
cases  appear  to  me  to  be  the  best  arranged  and  most  complete  of  any  of 
those  recorded  in  the  collection  : 

TREATMENT    OF    PLEURISY    AND    PERIPNEUMONIA. 

"  It  is  necessary  to  examine  in  the  following  manner  the  peripneumo- 
nic  and  pleuritic  aifections :  if  the  fever  is  acute ;  if  there  is  pain  in  one 
or  both  sides  of  the  chest ;  if  the  patient  suiFers  during  expiration ;  if 
he  coughs,  and  the  expectoration  is  rusty  or  livid,  or  thin  and  frothy,  or 
of  a  blood-red — if,  in  fine,  it  differed  at  all  from  that  which  is  natural, 
the  following  course  must  be  pursued :  the  pain  extending  above  and 
towards  the  clavicle,  or  towards  the  vein  and  the  arm,  the  internal  vein 
of  the  arm  on  that  side  should  be  opened.  The  quantity  of  blood  drawn 
should  be  proportional  to  the  constitution  of  the  body,  the  season  of  the 
year,  the  age  and  color  of  the  patient ;  and  if  the  pain  is  acute,  the 
bleeding  should  be  boldly  pushed  to  syncope;  afterward  an  injection  is 
to  be  administered. 

"  If  the  pain  occupies  the  inferior  region  of  the  chest,  and  if  the  ten- 
sion is  great,  you  should  prescribe  for  pleuritics  a  mild  purgation ;  but 
they  must  taste  nothing  else  while  the  medicine  is  operating.  After  the 
purgation  they  should  have  an  oxymel.  The  purgation  should  not  be 
administered  till  the  fourth  day :  during  the  first  three  days  injections 
should  be  employed ;  but  if  they  are  not  sufficient,  the  purge  should  be 
given,  as  above  said.  He  must  be  watched  until  the  fever  ceases  and  the 
seventh  day  is  attained ;  after  that,  if  he  appears  out  of  danger,  he  may 
take  a  little  barley-water,  weak  at  first,  and  sweetened  with  honey.  If 
the  convalescence  progresses  and  the  respiration  is  good,  the  tisane  may 
be  given  twice  a  day,  and  be  gradually  increased  in  quantity  and 
strength ;  but  if  the  convalescence  is  slow,  the  drink  must  be  lessened, 
and  for  nourishment  a  small  quantity  of  a  weak  tisane  once  a  day.     It 


-  See  §  G7,  G8,  69,  70,  GardeiL 


108  PHILOSOPHIC   PERIOD. 

should  be  given  when  the  patient  is  in  the  best  condition,  which  may  be 
known  by  the  appearance  of  the  urine. 

"  To  those  who  approach  the  close  of  the  disease,  it  is  not  necessary  to 
give  the  tisane,  before  you  see  the  coction  manifested  in  the  urine  or  ex- 
pectoration; nevertheless,  if,  when  purged,  the  patient  has  abundant 
evacuations,  it  is  necessary  to  give  the  tisane,  but  in  less  quantity  and 
weaker,  otherwise  the  emptiness  of  the  vessels  would  allow  him  neither 
to  sleep,  nor  to  digest  or  await  the  crisis.  With  this  exception,  the 
crude  humors  should  be  liquefied,  a'^d  whatever  has  been  the  obstacle,  be 
ejected :  then  nothing  prevents  alimentation.  The  expectoration  is  per- 
fectly concocted  when  it  appears  like  pus :  the  urine,  also,  when  it  has 
a  red  sediment,  like  brickdust. 

"  As  to  the  pains  in  the  side,  nothing  contra-indicates  the  use  of  fo- 
mentations and  wax  plasters.  The  legs  and  loins  should  be  rubbed  with 
warm  oil  and  then  anointed  with  fat.  The  hypochondria  should  be  cov- 
ered as  high  as  the  breasts  with  a  flaxseed  poultice.  When  the  peri- 
pneumonia has  reached  its  height,  nothing  can  be  accomplished  without 
purgation :  it  is  bad  if  the  patient  has  dyspnea,  or  the  urine  be  thin  and 
acrid,  or  there  be  sweats  around  the  neck  and  head.  These  sweats  indi- 
cate danger  in  proportion  to  the  violence  of  the  disease,  which  is  known 
by  the  suffocation  and  rattling,  which  increases  and  produces  death, 
unless  there  supervene  an  abundant  flow  of  viscid  urine  or  of  concocted 
sputa.  Whichever  of  these  two  phenomena  supervenes,  it  indicates 
resolution." 

An  eclegma  is  prescribed  for  peripneumonia,  with  galbanum  and  grains 
of  pine-seed,  in  Attic  honey.  Other  expectorants  are  employed,  such  as 
worm-wood  {Artemisia  abrotannm,  Lin.),  and  pepper  in  oxymel ;  pur- 
gatives :  boil  black  hellebore  {Hellehorus  orientalis,  Lin.) ,  and  give  it  as 
a  drink  to  pleuritics,  at  the  commencement,  and  while  the  pain  is  felt. 
A  useful  remedy  in  afiections  of  the  liver,  and  in  pains  proceeding  from 
the  diaphragm,  is  a  drink  of  opoponax  {Pastinacce  opoponax,  Lin.), 
boiled  in  oxymel  and  strained.  In  general,  a  remedy,  which  is  to  act 
on  the  stools  or  urine,  should  be  given  in  wine,  and  in  honey;  if  to 
act  on  the  stools  alone,  it  should  be  given  in  a  much  larger  quantity  of 
diluted  oxymel. 


§  VII.   External  NosoaRAPHY  and  Therapeutics,  or  Surgery. 

The  following  is  a  list  of  the  books  of  the  Hippocratic  collection,  that 
treat  of  external  nosography  and  therapeutics,  according  to  the  transla- 
tion of  Gardeil: 


SCHOOLS   OF  THE   ASCLEPIAD^.  109 

1 .  The  Laboratory  of  the  Surgeon,  in  which  dressings,  bandaging,  and 

the  use  of  apparatus  is  taught. 

2.  On  Fractures,  a  treatise  which  appears  above  the  anatomical  knowl- 

edge of  the  times. 

o.  On  Articulations  or  Luxations,  which  seems  to  be  a  continuation  of 
the  preceding  work. 

4r.  The  Mochlic,  an  extract,  or  small  abridgement  of  the  book  on  frac- 
tures, and  the  one  on  luxations. 

5.  Wounds  of  the  Head,  a  monograph,  extremely  remarkable  for  the 

perfection  with  which  the  subject  is  treated. 

6.  On  Sight,  and  Diseases  of  the  Fye,\^  mere  fragments,  not  of  much 

7.  On  Wounds,  )  value. 

8.  On  Fistula,      } 

9.  Hemorrhoids,   j  monographs,  passably  good. 

A  glance  of  the  eye  is  sufficient  to  show  that  a  great  amount  of  matter 
that  belongs  to  Surgery,  is  not  mentioned — such  as  penetrating  wounds 
of  the  chest  and  abdomen,  hernia,  and  vesicular  calculi.  The  Hippo- 
cratic  works  describe  only  a  very  small  number  of  surgical  operations, 
and  with  the  exception  of  the  treatises  on  fractures,  luxations,  and  the 
monograph  on  wounds  of  the  head,  it  may  be  said  of  all  the  other 
books  mentioned  above,  that  they  only  glance  at  the  subject  whose  title 
they  bear.  In  fine,  all  the  fragments,  re-united,  are  very  far  from  com- 
posing a  complete  treatise  on  surgery,  or  a  treatise  that  may  be  compared 
with  those  that  belong  to  the  next  historical  epoch ;  but  it  is  probable, 
and  even  certain  that  we  do  not  possess  all  the  surgical  works  of  the 
Hippocratic  authors ;  what  we  have,  though,  prove  that  the  Asclepiadse 
carried  this  branch  of  the  healing  art  to  a  degree  of  perfection  no  less 
remarkable  than  that  of  internal  Medicine. 


§  Vni.  Obstetrics. 

If  there  are  occasions,  when  the  aid  of  medical  knowledge  is  palpably 
necessary  and  efficacious,  they  present  themselves  especially  in  the  prac- 
tice of  obstetrics.  There,  often,  the  life  of  one  or  two  individuals,  in  per- 
fect health,  depends  on  a  manoeuver,  more  or  less  skillful,  or  an  indica- 
tion, more  or  less  well  fulfilled.  Beside,  the  duty  of  the  accoucheur,  or 
sage-femme,  is  not  limited  to  watching  and  giving  assistance  in  the  act 
of  parturition :  their  care  often  extends  throughout  the  entire  period  of 
gestation  and  lactation.  It  is  not,  then,  astonishing,  that  physicians 
were  occupied,  in  the  earliest  times,  with  this  branch  of  the  art,  and 


110  PHILOSOPHIC   PERIOD. 

that  legislators  have  subjected  it  to  special  regulations.  It  may  be 
inferred,  that  the  Asclepiadce  did  not  neglect  it,  from  the  simple  enume- 
ration of  the  writings  that  they  have  left  on  the  subject. 

T.   n,    OF   GARDEIL. 

1 .  A  monograph  on  Generation. 

2.  Do.  "      on  the  Nature  of  the  Infant. 

.3.  Do.         on  Pregnancy,  in  the  seventh  month. 

4.  Do.         on  Pregnancy,  in  the  eighth  month. 

5.  A  small  treatise  on  Accouchement,  entitled.  On  Superfetation ;  an 

excellent  abridgement  of  Obstetrics,  for  the  epoch, 
t).  A  small  fragment,  on  Dentition. 

T.  IV, 

7.  The  first  book  of  the  treatise  on  Diseases  of  Women. 

8.  A  fragment,  on  the  Extraction  of  a  Dead  Fetus, 

The  treatise  on  superfetation  does  not,  in  fact,  include  but  a  single 
paragraph  that  responds  to  its  title ;  all  the  rest  is  relative  to  accouche- 
ments.  We  there  find  a  succinct  and  methodic  resume  of  the  knowledge 
of  the  AsclepiadsB  on  this  subject,  and  I  can  not  do  better  than  refer  to  it 
the  reader,  who  is  desirous  to  inform  himself  on  the  state  of  the  art,  in 
the  age  of  Hippocrates,  This  abridgement  is  distinguished  for  its  inter- 
esting observations,  and  by  the  absence  of  certain  barbarous  and  gross 
practices,  that  impair  other  writings  of  the  same  collections. 

The  practice  of  sacades,  for  example,  is  not  mentioned  there,  which 
proves  that  the  author  did  not  approve  of  it ;  for  be  could  not  have 
been  ignorant  of  this  odd  proceeding,  which  is  mentioned  in  several  of 
the  Hippocratic  works ;  notably  in  the  first  book  of  the  treatise  on  the 
diseases  of  women,  where  it  is  minutely  described,'-- 

Apropos  to  this  last  treatise.  I  will  observe,  that  its  author,  whenever 
he  speaks  of  matters  relating  to  accouchements,  addresses  himself  to 
midwives,  which  makes  it  probable  that  the  ordinary  practice  of  obstet- 
rics was  committed  to  them,  and  physicians  were  only  called,  in  grave 
or  extraordinary  cases. 


§  IX.  Clinics. 

The  clinic  does  not  form  a  particular  branch  of  medical  science ;  it 
embraces  all,  and  makes  the  application  of  them  at  the  bedside — it 

-  CEuvres  d'  Hippocrate,  §  81  de  Gardeil. 


SCHOOLS   OF  THE   ASCLEPIAD^.  Ill 

constitutes  the  highest  degree  of  medical  teaching.  There,  the  master 
unites,  constantly,  example  to  precept — practice  to  theory.  Nothing 
is  better  calculated  to  mature  the  experience  of  young  men,  than  thoso^ 
lessons  which  are  given  at  the  bedside  of  the  sick,  when  he  who  has 
charge  of  the  patients,  unites  profound  instruction  with  great  probity ; 
and  by  this  last  term  we  comprehend,  with  a  modern  professor,  candor, 
frankness,  justice,  humanity,  and  disinterestedness.  M.  Bouillaud 
insists,  justly,  on  the  necessity  of  joining  moral  qualities  to  knowledge 
in  the  practice  and  teaching  of  Medicine.  He  clearly  demonstrates, 
that  in  default  of  morality,  the  most  beneficent  act  is  only  an  instru- 
ment of  deception,  and  a  dangerous  weapon,  in  unsafe  hands.  He  defines 
the  true  physician  to  be  an  honest  man,  instructed  in  the  art  of  healing. 
Vir  probus  medendi  peritus ;  a  definition  which  cannot  be  too  much 
popularized,  for  it  shows  to  the  public  what  are  the  qualities  they  must 
seek  in  a  man  to  whom  they  confide  their  health.-' 

It  was  as  much  by  his  virtues  as  by  his  genius,  that  Hippocrates 
gained  universal  approbation.  These  virtues  shine  with  great  eclat  in 
the  clinical  observations  which  he  has  transmitted  to  us.  He  never 
appears  there  as  laboring  for  a  reputation  ;  the  sole  desire  that  animates 
him  is,  to  be  useful  to  his  fellows,  in  enlightening  them  on  the  means 
of  preserving  health,  or  in  curing  diseases.  He  avows,  with  an  ingenu- 
ousness that  finds  few  imitators,  his  reverses  and  faults,  convinced, 
doubtless,  that  instruction  is  as  much  given  in  pointing  out  an  error,  as 
in  showing  the  truth. 

The  most  ancient  collection  of  clinics  bears  the  title  of  Epidemics. 
These  sort  of  afflictions  leave  in  the  minds  of  the  people  such  impres- 
sions of  astonishment  and  terror,  that  other  than  medical  writers  have 
not  disdained  to  trace  their  history,  as  extraordinary  events  of  interest 
to  posterity.  It  was  then  entirely  natural  that  physicians  should  relate 
detailed  accounts  of  them ;  not  for  the  simple  purpose  of  interesting  or 
gratifying  the  curiosity  of  the  reader,  but  in  the  hope  of  finding  some 
means  to  prevent  the  return  of  similar  pests,  or  of  moderating  their 
eff"ects. 

To  attain  this  end,  physicians  proposed,  in  the  first  place,  to  ascer- 
tain the  cause  of  epidemics.  The  following  is  their  reasoning,  to  prove 
that  it  is  always  in  the  atmosphere :  "  Some  diseases,"  say  they,  "  come 
from  the  regimen,  others  from  the  air  which  we  breath  to  maintain  life. 
Where  several  persons  are  attacked  at  the  same  time  and  place  by  the 
same  disease,  we  must  seek  the  cause  in  that  which  is  most  common  to 
all,  and  this  is  the  atmosphere.     It  is  manifest,  then,  that  these  aflfec- 

»  Essai  de  Philos.  Medicale,     Paris,  1837,  p.  239. 


112  PHILOSOPHIC   PERIOD. 

tions  do  not  proceed  from  the  regimen,  because  they  attack  every  one 
indifferently  ;  men  as  well  as  women  ;  hard  drinkers  as  well  as  those  who 
drink  only  water ;  the  industrious  as  well  as  the  idle ;  those  who  live 
luxuriously  as  well  as  those  who  have  only  bread  for  food.  So  then, 
when  an  epidemic  prevails,  the  cause  certainly  does  not  exist  in  our  re- 
gimen, but  in  the  air  we  inspire,  receiving  from  it  some  deleterious 
element.'"' 

This  reasoning  cannot  be  objected  to  unless  it  be  thought  too  absolute, 
for  epidemic  affections  may  be  developed  under  the  influence  of  a  bad 
alimentation,  in  countries  where  famine  prevails,  in  besieged  cities,  in 
ahips,  etc. ;  others  spring  from  moral  causes,  such  as  the  discouragement 
which  follows  a  retreat,  religious  exaltation  produced  by  fanatical 
preaching,  or  from  persecutions.! 

Nevertheless,  it  cannot  be  denied  that  the  air  is  the  most  active  me- 
dium— the  most  powerful  vehicle  of  epidemics,  especially  of  those  that 
ravage  large  districts,  and  for  a  considerable  length  of  time. 

Another  very  important  observation,  which  did  not  escape  the  Ascle- 
piadse,  is  that  during  the  reign  of  epidemics,  the  most  varied  intercur- 
rent affections  have  a  particular  physiognomy  which  is  common  to  all, 
and  which  gives  them  a  familiar  likeness. 

Eesting  upon  this  double  basis,  the  Hippocratic  writers  believe  it  im- 
portant to  note  with  care,  the  state  of  the  atmosphere  before  and  during 
the  epidemics,  and  they  have  described  with  not  less  exactness,  the  gene- 
ral character  of  intercurrent  diseases.  In  this  way,  connecting  the 
meteorological  phenomena  with  the  morbid  ones  observed  during  a  season 
or  a  year,  they  describe  what  has  been  named  the  epidemic  constitution 
of  that  season  or  year.  They  hoped,  that  after  having  thus  described  a 
great  number  of  medical  constitutions,  they  would  be  able  to  ascertain 
what  atmospheric  conditions  habitually  preceded  and  accompanied  dif- 
ferent epidemics,  so  that  it  would  be  possible,  in  certain  cases,  to  foresee 
the  advent  of  the  scourge,  and  prepare  for  it. 

Such  was  the  hope  also  of  Sydenham  and  Stohl,  worthy  emulators  of 
Hippocrates,  when  they,  with  admirable  patience,  prepared  their  tables 
of  medical  constitutions.  Too  few  physicians  have  had  the  courage  to 
follow  in  their  footsteps.  The  happy  mortal  to  whom  is  reserved  the 
honor  of  determining  the  relation  or  law  that  connects  epidemics  with 
certain  states  of  the  atmosphere,  has  not  yet  appeared. 

"^Hippocratic  Works.    Treatise  on  the  Nature  of  Man,  Vol.  1,  sec.  10  and  11. 
Gardeil. 
f  Raphania,  or  the  disease  of  fanatics,  scurvy,  and  convulsions  of  St.  Medard,  etc. 


SCHOOLS   OF  THE   ASCLEPIAD^.  113 

Seven  books  of  the  Hippocratic  collection  bear  the  title  of  Epidemics. 
Xevertheless,  the  first  and  the  third  alone  are  devoted,  effectively,  to  the 
description  of  epidemic  constitutions,  and  appear  to  follow  each  other. 
On  this  account,  they  are  considered  as  being  connected,  and  are  sepa- 
ated  from  the  others,  which  are  not  supposed  to  belong  to  Hippocrates. 
He  describes  in  the  first  place,  the  most  remarkable  atmospheric  condi- 
tions ;  afterwards,  the  general  character  exhibited  by  intercurrent  dis- 
eases by  the  constitution ;  finally,  he  traces  the  particular  history  of 
some  diseases.  The  following  extract  will  enable  the  reader  to  judge  of 
the  method  and  talent  for  observation  displayed  by  the  author. 

FIRST   CONSTITUTION." 

"In  the  island  of  Thasos,  during  autumn,  towards  the  equinox,  and 
whilst  the  Pleiades  were  at  the  horizon,  (that  is,  for  those  fifty  days 
after  the  autumnal  equinox),  there  were  gentle,  continuous  and  abund- 
ant showers,  southerly  winds,  and  open  winter,  with  slight  breezes  from 
the  north,  and  dryness  ;  in  sum  the  whole  winter  seemed  like  spring. 
The  spring  season,  in  its  turn,  was  marked  by  south  winds,  coolness  and 
slight  showers.  The  summer  was  in  general,  cloudy  without  rain  ;  the 
monsoon  seldom  blew,  and  with  but  little  force  or  regularity. 

"  All  the  atmospheric  conditions  having  been  southern  and  dry,  an  in- 
terval in  this  constitution,  opposite  and  northern,  occurring  in  the  be- 
ginning of  spring,  developed  some  cases  of  remitting  fever ;  but  they  were 
generally  moderate.  There  were  but  few  attended  with  nasal  hemorrhage, 
and  no  one  died.  Tumors  were  developed  in  several  persons — on  one  side 
only  in  the  greater  number ;  but  no  one  had  so  much  fever  as  to  be 
obliged  to  keep  his  bed ;  though  some  had  a  little  heat  of  skin.  These 
tumors  disappeared  in  all  cases  without  any  difficulty ;  there  was  no 
suppuration,  which  so  often  happens  with  tumors  arising  from  other 
causes.  They  were  large,  soft,  diffused,  without  inflamation  or  pain, 
and  disappeared  without  any  critical  sign.  They  were  manifested  in 
youths,  in  men  in  the  flower  of  their  age,  and  especially  in  those  who  took 
gymnastic  exercises ;  few  women  were  attacked.  The  greater  number 
of  the  afflicted  had  dry  coughs,  with  hoarseness,  but  no  expectoration." 

Very  soon,  in  some,  but  later  in  others,  there  was  developed  a  painful 
inflamation  of  the  testicle,  some  times  on  one  side,  then  on  both.  Fever 
was  not  always  present,  but  there  was  much  suffering.  It  is  to  be  added, 
that  the  Thasians  did  not  seek  medical  "  advice." 

The  above  is  an  account  of  the  Medical  Constitution  for  the  end  of 

*""Work3  of  Hippocrates,  by  Littre,  Vol.  2,  p.  599.     Epidemics,  Book  1,  sec.  1. 


114'  PHILOSOPHIC   PERIOD. 

winter  and  the  spring.  The  author  describes  consecutively,  that  of  the 
summer  and  autumn,  after  which  he  reports  some  historical  particulars. 

"  First  patient — Philiscus — lived  near  the  wall.  He  took  to  bed. 
First  day :  acute  fever,  sweat ;  a  bad  night.  Second  day :  general  ex- 
acerbation ;  in  the  evening,  a  small  injection  procured  ftvvorable  evacua- 
tion ;  a  tranquil  night.  Third  day :  in  the  moi'ning,  and  until  mid-day, 
the  fever  appeared  to  have  ceased,  but  towards  evening,  acute  fever,  with 
sweat ;  tongue  begins  to  be  dry  ;  urine  dark ;  he  passed  a  painful  night, 
without  sleep,  and  had  hallucinations  on  all  subjects.  Fourth  day  : 
general  aggravation  ;  dai-k  urine ;  the  night  was  passed  better,  and  the 
urine  better  colored.  Fifth  day  ;  towards  the  middle  of  the  day,  he  had 
a  slight  epistaxis  of  vei-y  dark  blood  ;  urine  varied,  a  cloudy  substance 
similar  to  sperm,  floating  in  it,  but  without  precipitating  ;  after  a  supo- 
sitory,  he  passed  a  little  feces,  with  wind.  The  night  was  uncomfortable  ; 
short  naps ;  he  talked  much  in  a  rambling  way ;  all  the  extremities 
were  cold,  and  could  not  be  warmed  ;  he  passed  dark  urine ;  slept  a  little 
towards  day ;  became  speechless ;  cold  sweat  and  livid  extremities.  He 
died  about  the  middle  of  the  sixth  day. 

"  In  this  patient  the  respiration  was,  to  the  end,  full  and  slow,  as  if 
he  had  to  remember  to  breathe.  The  spleen  was  swelled  and  formed  a 
round  tumor:  the  cold  sweat  continixed  till  the  last:  the  access  was 
every  other  day." 

The  above  tableau  gives  an  idea  of  the  whole  of  the  morbid  phenom- 
ena, though  it  leaves  something  to  desire,  as  we  shall  show  presently. 
There  is  no  comparison  possible  between  a  narration  thus  made  and  the 
miserable  votive  tablets  suspended  on  the  columns  of  the  temples.  The 
first  and  third  books  on  Epidemics  include  together  forty-two  particular 
histories,  similar  to  that  given  above.  Twenty-five  of  these  terminated 
fatally,  and  seventeen,  only,  favorably. 

Certain  critics  have  taken  occasion,  from  this  frightful  mortality,  to 
blame  the  curative  method  of  Hippocrates ;  but  they  show  that  they  are 
superficial  observers,  or  they  would  have  seen  that  Hippocrates  only 
gives  the  detailed  history  of  the  gravest  and  most  remarkable  cases. 
The  proportion  of  fatal  cases  would  have  been  much  less,  if  he  had  in- 
cluded all  his  cases.  This  conclusion  is  not  a  conjecture — it  is  proven 
from  many  passages  of  our  author ;  among  others,  in  a  remark  cited 
above,  in  the  description  of  the  first  medical  constitution:  "All  the 
atmospheric  conditions  having  been  southern  and  dry,  an  interval  in 
which  the  constitution  was  opposite  and  boreal,  at  the  beginning  of 
spring,  originated  some  fevers.  These  fevers  were  generally  moderate ; 
a  few  had  nasal  hemorrhages,  but  none  died." 

A  reproach  much  better  founded  might  be  made  to  the  clinical  rela- 


SCHOOLS   OF  THE   ASCLEPIAD^.  115 

tions  of  the  old  man  of  Cos.  viz  :  for  having  said  nothing,  or  next  to  no- 
thing, of  the  regimen  and  treatment  to  which  he  submitted  the  sick. 
This  omission  is  keenly  felt,  rendering  it  impossible  for  the  reader  to 
appreciate  the  curative  method  of  the  physician.  It  forms  an  important 
vacuum  in  the  history  of  the  disease ;  for  it  is  evident  that  the  thera- 
peutic or  hygienic  means  employed  during  the  course  of  a  disease  affect 
the  progress  and  duration  of  it,  however  simple  they  may  have  been. 
It  is  not  a  matter  of  indifference,  for  example,  whether  a  sick  person  be 
placed  in  a  convenient  chamber,  warmed  and  ventilated,  or  in  a  small, 
obscure,  cold,  and  infected  apartment;  or  whether  he  is  permitted  to 
drink  wine  without  discretion,  or  only  to  have  pure  water. 

The  five  other  books  on  Epidemics  contain  clinical  observations,  col- 
lected without  order,  and  relating  to  all  sorts  of  diseases.  A  great  num- 
ber of  these  histories  are  only  simple  notes  or  detached  reflections ;  some, 
however,  are  edited  with  taste  and  completeness.  The  mention  made  in 
these,  of  the  treatment,  shows  a  progress,  compared  with  the  preceding 
ones.     Here  is  one  of  the  best,  I  think,  though  not  one  of  the  longest. 

Edematous  swelling  during  pregnancy ;  great  dyspnea  ;  expectoration 
of  a  large  amount  of  pituitous  matter ;  improvement. 

"  The  sister  of  Harpalides,  being  in  the  fourth  or  fifth  month  of  preg- 
nancy, an  aqueous  swelling  commenced  at  the  feet  and  around  the  eyes ; 
the  skin  became  swelled  up,  as  in  phlegmatic  persons  :  dry  cough ;  some- 
times orthopnea ;  the  dyspnea  and  suffocation  were  such  that  the  patient 
sat  up  in  her  bed,  being  unable  to  lie  down ;  and  if  she  felt  sleepy,  it 
was  when  sitting  up.  Beyond  this  there  was  little  fever :  the  fetus  was 
for  a  long  time  still,  as  if  it  were  dead,  and  it  fell  about,  following  the 
position  of  the  woman.  The  dyspnea  persisted  for  two  months ;  but  the 
patient  making  use  of  Egyptian  beans,  {nympluea  nelumho,  Lin.),  pre- 
pared with  honey  and  with  a  honeyed  eclegma,  and  drinking  the  cumin 
of  Ethiopia,  in  wine,  her  condition  improved;  her  expectoration  became 
abundant,  looked  mucoid  and  white  ;  the  dyspnea  ceased.  She  brought 
forth  a  female  child."  '■■' 


§  X.     Aphorisms. 

I  will  terminate  this  succinct  review  of  the  Hippocratic  collection,  by 
the  examination  of  a  work  which  was  intended  as  a  recapitulation  of  all 
that  is  set  forth  in  the  others.  I  mean  the  collection  of  Aphorisms,  in 
seven  of  his  books.     Ko  medical  work  of  antiquity  has  had  a  more  colossal 

"  Works  of  Hippocrates, — Epidemics,  book  vii. 


116  PHILOSOPHIC   PERIOD. 

reputation  than  this ;  physicians  and  philosophers  have  professed  for  it 
the  same  veneration  as  the  Pjthagorians  manifested  for  their  golden 
verses.  The  aphorisms  of  Hippocrates  were  long  regarded  as  the  crown- 
ing glory  of  the  medical  scientific  edifice — as  the  most  sublime  effort  of 
medical  genius.  Only  a  few  years  past,  the  faculty  of  Paris  required  of 
the  aspirants  to  the  doctorate  to  insert  a  certain  number  of  them  in  their 
theses ;  and  perhaps  nothing  less  than  the  political  revolution  in  France 
was  sufficient  to  overthrow  this  old  relic  of  a  superannuated  adoration. 

For  some  propositions  that  express  general  truths  of  recognized  util- 
ity, and  some  clear  and  profound  observations,  how  many  are  there  that 
contain  exceptional  truths,  vulgar  reflections,  and  even  errors  and  con- 
tradictions. In  a  practical  point  of  view,  the  Aphorisms  appear  to  me 
to  be  nearly  an  absolute  nullity ;  because,  having  no  union  with  each 
other,  they  make  only  a  superficial  impression  on  the  mind  of  the  reader, 
and  are  easily  effaced  from  his  memory.  Besides,  in  admitting  even 
that  a  practitioner  might  have  them  all  at  his  fingers'  ends,  they  would 
not  render  him  much  more  skillful  in  treating  diseases.  Such  reading, 
then,  can  offer  no  solid  instruction  to  the  student,  nor  is  it  valuable  to 
any  but  a  practitioner  whose  judgment  is  ripened  by  experience,  for  he 
alone  is  capable  of  discerning  what  is  true  and  what  is  false,  or  the  good 
and  the  bad  in  these  general  maxims :  to  him  they  are  merely  a  recapit- 
ulation of  scattered  notions  and  observations. 

This  was  my  judgment  of  them  long  before  M.  Littre  had  published 
his  translation  of  this  Hippocratic  treatise.  Since  I  have  read  the 
learned  explanations  of  this  commentator  I  have  not  changed  my  mind, 
for  it  seems  to  me  that  both  of  us  consider  these  famous  sentences  from 
different  points  of  view — he  as  an  erudite  and  a  philosopher,  and  I  as  a 
simple  practitioner.  "The  Aphorisms  form,"  says  M.  Littre,  "  a  suc- 
cession of  propositions  in  juxtaposition,  but  not  united.  It  is,  and 
always  will  be,  disadvantageous,  for  a  work  to  be  written  in  that  style, 
and  this  disadvantage  is  increased  if  the  Aphorisms  are  considered  with 
modern  ideas,  and  with  the  notions  we  now  have  of  physiology  and  path- 
ology :  they  thus  lose  all  their  general  signification,  and  the  aphorism, 
already  so  isolated  in  itself,  becomes  more  so  when  introduced  into  mod- 
em science,  with  which  it  has  but  little  practical  relationship.  But  it  is 
not  so  when  the  mind  conceives  of  the  ideas  which  prevailed  when  the 
Aphorisms  were  written:  then,  in  those  parts  where  they  seem  most  dis- 
jointed, we  see  that  they  are  related  to  a  common  doctrine,  which  unites 
them  together ;  and  in  this  view,  they  no  longer  appear  as  detached 
Bentences.* 

•"'Aphorismes,  Argument,  §  11,  Tome  IV.,  page  405,  des  (Euvres  d'Hippocrate. 


SCHOOLS   OF   THE   ASCLEPIAD^.  117 


ART.    III.     THEORIES    AND    SYSTEMS. 

Now,  after  having  considered  the  state  of  Medicine  under  the  Ascle- 
piadce,  in  the  isle  of  Cos,  in  an  exclusively  practical  manner,  and,  in 
some  sort,  material  also,  it  remains  for  us  to  examine  it  in  a  theoretical 
point  of  view  —  to  seek  the  invisible  bond  that  unites  all  parts  of  their 
doctrines,  and  connects  them  to  a  common  principle,  as  the  branches  of 
the  same  tree. 

In  all  times,  and  perhaps  in  ours  more  than  any  other,  systems  have 
been  decried.  They  have  been  and  are  still  accused  of  being  only  a 
tissue  of  errors  and  a  source  of  eternal  discussion.  The  epithet  sys- 
tematic, (theoretic  —  with  us.  TV.)  applied  to  an  author  or  a  book,  has 
become  an  expression  of  disdain.  Many  would  banish  from  Medicine  all 
theory,  all  system,  and  preserve  only  the  facts  and  results  of  experience. 
Their  plan  appears  very  commodious  and  sure,  at  first  sight,  but  when 
more  closely  examined,  it  is  impracticable.  Those  who  have  recom- 
mended it  the  most,  have  not  been  able  to  avoid  violating  the  plan,  in 
their  writings  as  well  as  in  their  practice.  M.  Bouillaud  • '  demonstrates 
this  in  a  positive  manner ;  and  M.  Monfalcon,  but  little  favorable  to 
systematic  writers,  is  also  forced  to  say  :  "  Much  has  been  said  against 
systems  and  certainly  with  truth.  We  condemn  them  and  still  we 
are  not  able  to  do  without  them.  Every  instructed  physician  has  a 
way  of  explaining  to  himself  life  and  diseases  ;  he  wishes  to  form  an 
opinion  of  what  he  sees  as  well  as  of  what  he  do:s.  If  the  received 
doctrines  do  not  satisfy  him,  he  modifies  them,  in  a  way  most  satis- 
factory to  himself."  f 

I  will  add,  that  learned  physicians  are  not  the  only  ones  that  essay 
to  interpret  the  phenomena  of  life  ;  for  in  this  respect  the  most  igno- 
rant are  no  less  prodigal  in  explanations,  nor  less  prepossessed  in 
their  manner  of  regarding  them  ;  so  natural  and  irresistible  is  the 
impulse  to  try  to  explain  the  phenomena  that  strike  our  senses. 

In  fact  I  may  say,  without  a  theory,  without  some  systematic  arrange- 
ment of  partial  opinions  that  tend  toward  a  common  end,  there  exists 
no  science.  Clinical  observations,  collected  with  care,  but  arranged  with- 
out art  and  method,  in  a  word,  without  system,  constitute  no  more  a 
scientific  edifice,  than  a  confused  pile  of  materials  constitutes  a  monument 
of  architecture. 

Theories  and  systems  concur  to  the  advancement  of  the  sciences  by 
uniting  by  an  artificial  bond  the  diverse  notions  of  which  they  are  com- 

°  Essai  de  Philos.  Medicale.     Paris,  18.37,  deuxieme  partie,  chap,  in,  art.  1,  §  1. 
t  Diction,  des  Sciences  Medicales,  the  words  System  and  Theorie. 


118  PHILOSOPHIC    PERIOD. 

posed,  in  a  way  to  assist  the  memory,  and  enlighten  the  judgment.  It  is 
true  that  scientific  systems  sometimes  propagate  illusions  and  ridiculous 
prejudices,  but  the  illusions  and  prejudices  that  spring  from  ignorance 
and  barbarism,  that  is  to  say,  from  the  absence  of  all  reasonable  system, 
are  no  less  numerous,  ridiculous,  and  absurd. 

A  system  is  true,  when  it  is  founded  on  real  analogies  ;  it  is  false, 
when  it  rests  on  imaginary  analogies.  A  system  may  be  true  in  certain 
parts,  and  false  in  others  ;  but  there  are  few  systems  that  are  entirely 
erroneous.  This  is  also  the  opinion  of  the  writer  that  I  have  just  cited. 
"  If  systems,"  says  M.  Monfalcon,  "  were  composed  only  of  errors,  of 
conjectural  opinions,  they  Avould  make  but  few  partisans  ;  but  there  is 
not  one  that  does  not  repose  on  some  important  fact  or  some  well  recog- 
nized physiological  law.  Those  who  propose  them  do  no  other  wrong 
than  exagerate  these  laws  and  make  the  whole  of  Medicine  subordinate 
to  them  :  those  who  adopt  them  see  only  one  side  of  the  subject,  and  sub- 
mit too  blindly  to  the  reason  of  one  single  man.--= 

Thus  then  the  most  common  defect  of  medical  systems  is  not  a  lack 
of  foundation,  nor  the  want  of  a  support  derived  from  correct  observa- 
tion, but  it  is  rather  the  exageration  of  certain  truths,  to  the  neglect 
of  others  not  less  important  —  the  consideration  of  objects  too  exclu- 
sively under  one  aspect.  "  The  fault,"  says  Bichat,  "  with  these  who 
have  a  general  idea  on  Medicine,  is  to  bend  all  the  phenomena  to  this 
idea.  The  defect  of  generalizing  too  much  has  perhaps  been  more  injuri- 
ous to  science,  than  that  of  seeing  each  phenomenon  in  an  isolated  manner. f 

Being  convinced  of  the  necessity  of  theories  to  harmonize  the  various 
ramifications  of  science,  persuaded  that  without  their  aid  the  human 
understanding  could  not  grasp  a  great  extent  of  knowledge,  nor  elevate 
itself  to  the  highest  considerations,  we  shall  accord  to  this  important 
branch  of  Medicine  all  the  attention  that  it  merits,  without  forgetting 
that  it  offers  only  an  ideal  and  an  imperfect  image  of  phenomena,  and 
that  it  can  not  in  any  case  replace  the  study  of  real  nature,  or  take  the 
place  of  direct  observation. 


§  I.  Theory  of  Coctiox  and  Crisis. 

The  theory  which  prevails  the  most  universally  in  the  Hippocratic 
works,  is  that  of  coction  and  crisis.  It  is  met  with  at  every  step,  some- 
times isolated,  sometimes  combined  with  others  ;  but  especially  is  it 
united  to  the  system  of  four  elements  and  four  humors.     It  forms  an 

^^  Diction,  des  Scienc.  Medic,  the  word  System, 
f  Anat.  Ge'n.,  Considerat.  Ge'n.,  p.  1-3. 


SCHOOLS   OF   THE   ASCLEPIADJi;.  119 

integral  part  and  is  the  most  characteristic  trait  of  the  ancient  Dogma- 
tism, and  it  is  retained  even  in  our  time,  while  all  its  cotemporaneous 
doctrines  have  heen  abandoned. 

The  Asclepiadae,  of  the  isle  of  Cos,  regarded  disease  as  an  association 
of  phenomena,  resulting  from  the  efforts  made  by  the  conservative  prin- 
ciple of  life  to  effect  a  coction  of  the  morbific  matter  in  the  economy. 
They  thought  that  it  could  not  be  advantageously  expelled  until  it  was 
properly  prepared,  that  is,  until  after  its  elements  were  separated  and 
united  with  the  natural  humors  of  the  body,  so  as  to  form  an  excremen- 
titious  material. 

The  vital  principle  that  effected  this  preparatory  work,  as  well  as 
sustained  all  other  physiological  functions,  has  received  various  names 
among  ancient  authors,  according  to  their  notions  of  its  particular  attri- 
butes. Som  ecalled  it  nature,  ipuai^,  when  they  wished  to  indicate 
the  totality  of  forces  and  phenomena  over  which  it  presided ;  motor, 
VyOrjiiioi^,  impetum  faciens,  to  signify  the  prompt  impulse  which  it  gave 
to  the  whole  machine;  soul,  spirit,  i^'oyr,,  to  signify  its  immaterial 
essence,  and  the  noblest  of  its  faculties — the  intellect.  The  word 
ri/£'j«a,  breath,  designated,  more  particularly,  the  way  in  which  the 
vital  principle  sustained  itself,  the  substance  from  which  it  drew  its 
nourishment:  and  the  word  dsfiuov,  heat,  expressed  one  of  the  most 
immediate  effects,  and  the  most  indispensable  to  life. 

"When  the  morbid  substance  approaches  the  period  of  maturity,  nature 
seems  to  redouble  her  efforts ;  the  fever  augments,  the  patient  is  over- 
whelmed, or  delirious,  all  the  symptoms  are  aggravated  and  announce 
the  approach  of  a  revolution;  this  was  the  moment  of  the  crisis,  or 
judgement  of  the  disease.  The  day  on  which  it  was  accomplished,  the 
signs  which  preceded  or  accompanied  it  were  termed  critical,  and  required 
the  special  observation  and  attention  of  the  physician.  He  must  be 
able  to  discern  whether  these  signs  were  good  or  bad,  and  predict,  on 
seeing  them,  what  will  be  the  fate  of  the  patient.  He  must  respect  the 
critical  labor  of  nature,  if  it  proceed  properly,  nor  disturb  it  by  vio- 
lent remedies,  and  in  no  case  attempt  to  aid  the  vital  principle,  unless 
in  urgent  necessity. 

When  the  coction  was  effected,  which  might  be  known  by  the  amend- 
ment of  the  symptoms,  it  only  remained  to  evacuate  the  heterogeneous 
material.  Nature  often  accomplishes  this  last  effort,  herself,  and  the 
disease  terminates  by  a  critical  sweat,  urination,  or  stools.  But  it  also 
frequently  happens,  that  the  vital  principle,  fatigued  and  broken  down 
by  the  efforts  of  the  crisis,  requires  aid,  and  then  the  physician  must 
come  to  its  relief.  To  accomplish  this,  say  the  authors,  he  must  push  the 
material  toward  the  emunctory,  to  which  it  naturally  tends ;  that  is,  he 


120  PHILOSOPHIC   PERIOD. 

must  give  sudorifics,  or  purgatives,  or  diuretics,  according  to  the  indi- 
cations of  nature,  whose  faithful  minister  he  must  show  himself  to  be,  in 
all  things.  In  this  way  diseases  terminated,  in  the  most  favorable  cases."- 

But  it  might  happen,  that  the  coction  could  not  be  effected,  or  only 
imperfectly.  In  such  cases,  one  of  two  things  must  occur :  either  the 
vital  principle,  overcome  by  the  morbid  element,  succumbs,  and  the 
patient  dies,  or  the  struggle  between  the  vital  element  and  the  morbid 
goes  on,  and  a  new  effort  at  coction  commences,  and  is  continued  for  a 
limited  number  of  days,  in  the  same  manner  as  at  first.  This  second 
effort  may  have  a  termination,  complete  or  incomplete,  and  so  on  succes- 
sively. 

The  number  of  days  necessary  for  the  coction,  or  the  elaboration  of 
the  morbigenous  matter,  was  termed  the  critical  period.  The  most  per- 
fect period  was  supposed  to  be  the  quaternary,  or  that  of  four  days ; 
next,  the  third ;  finally,  in  addition  to  these  two,  was  the  septenary. 
which  had  a  high  consideration. 

In  the  treatise  on  Prognostics,  section  20,  we  read  as  follows:  "the 
same  number  of  days  which  brings  about  the  cure,  or  death  of  the  sick, 
regulates  the  crises  of  fevers.  The  most  benign,  those  which  are  accom- 
panied with  the  most  encouraging  signs,  terminate  in  four  days,  or 
sooner ;  the  most  malignant,  or  those  accompanied  with  the  most  mena- 
cing signs,  destroy  life  in  four  days,  or  less :  such  is  the  limit  of  the 
first  period.  The  second  period  reaches  the  seventh  day ;  the  third,  the 
eleventh  day ;  the  fourth,  the  fourteenth  day ;  the  fifth,  the  seventeenth 
day;  the  sixth,  the  twentieth  day.  Thus,  these  periods,  in  the  most 
acute  diseases,  go  from  the  first,  in  four  days,  to  the  sixth  in  twenty  days. 
But  none  of  these  periods,  they  say,  can  be  calculated,  rigorously,  by  entire 
days,  for  neither  the  year,  nor  the  months,  are  counted  by  entire  days. 
Still  farther,  by  the  same  calculation,  and  same  progression,  we  have  a 
first  period  of  thirty-four  days,  a  second  of  forty,  and  a  third  of  sixty 
days.  The  most  difficult  part  of  the  diagnosis  is.  to  determine  from  the 
beginning  the  favorable,  or  unfavorable  termination  of  those  cases  in 
which  the  crises  are  slowest ;  for,  in  the  beginning,  all  protracted  dis- 
eases are  very  similar.  It  is  necessary  to  make  observations  from  the 
first  day,  and  then  examine  the  state  of  things,  after  each  quaternary  is 
passed;  in  this  way,  mistakes  in  regard  to  the  termination  of  diseases 
are  avoided.  The  nature  of  the  quartan  fever  is  submitted  to  a  similar 
course.  The  good  or  bad  termination  of  a  case,  when  the  crisis  is 
reached  in  the  shortest  time,  is  more  easily  known,  for  the  accessions 
are  extremely  dissimilar.     The  patients  who  will   recover,   have  easy 

^CEuvres  d'  Hippocrate,  par  M.  Littre,  T.  V.  Traite  des  humours,  §  3,  et  als. 


SCHOOLS  OF  THE  ASCLEPIADJE.  121 

respiration,  not  much  suflPering,  sleep  at  night,  and  offer  otherwise  encour- 
aging symptoms :  on  the  other  hand,  those  that  are  to  die,  have  dyspnoea, 
delirium,  sleeplessness,  and  all  the  most  alarming  signs.  Since  these 
affections  thus  act,  it  is  necessary  to  establish  conjectures  according  to 
the  time,  and  according  to  each  additional  period,  in  proportion  as  the 
diseases  proceed  toward  the  crisis.  With  women,  the  crisis,  after 
accouchement,  follows  the  same  rule."" 

In  the  above  scale  of  critical  days,  it  may  be  observed  that  each  pe- 
riod is  formed  by  adding  the  r  umber  four  or  three  to  the  preceding  one. 
To  properly  conceive  of  the  origin  of  this  progression,  we  must  recur  to 
the  system  of  Pythagoras,  already  described.f  The  number  four,  it  may 
be  remembered,  represents  in  that  system  all  substances  endowed  with 
proper  faculties,  having  an  existence  distinct  from  other  beings,  as  God, 
man,  a  plant,  or  a  mineral ;  hence  it  follows  that  the  Asclepiadre,  inhe- 
ritors of  the  doctrines  and  symbolical  language  of  the  Egyptians,  were 
naturally  led  to  designate  by  the  number  four  the  morbid  entity  come 
to  its  complete  development.  For  the  same  reason,  the  number  three, 
which  represented  the  whole  of  the  essential  properties  of  all  beings, 
might  also  indicate  to  them  the  plenitude  of  the  faculties  of  the  morbid 
entity. 

If  any  doubt  yet  remains  on  the  connection  that  exists  between  the 
system  of  Pythagoras  and  the  theory  of  critical  days,  the  following  pas- 
sage will  remove  them : — "  A  physician,  says  one,  who  neglects  nothing 
that  may  contribute  to  the  establishment  of  his  patient's  health,  must 
observe  carefully  what  passes  each  day.  Among  those  days  of  even  num- 
bers, the  most  important  are  the  fourteenth,  the  twenty-eighth,  and  the 
forty-second.  This  is  supposed  to  arise  from  the  perfection  of  those 
numbers,  and  the  manner  in  which  they  are  composed  of  other  whole 
numbers.  It  would  take  up  too  much  time  to  give  their  reasons :  it  will 
be  sufficient  to  say  that  they  refer  to  the  ternary  and  quarternary."J 

As  nature  is  not  subjected  to  our  arbitrary  limitations,  it  often  hap- 
pens that  the  duration  of  diseases  does  not  respond  exactly  to  an  exact 
number  of  ternary  or  quarternary  periods ;  they  were  therefore  obliged 
to  change  more  than  once  the  manner  of  counting  critical  days.  Opinions 
varied  very  much  in  that  respect,  even  in  ancient  times.  The  author  of 
the  treatise  on  Diseases  developed  in  his  fourth  book  a  physiological  and 
pathological  theory,  according  to  which  all  the  odd  days  are  assumed  to- 
be  critical  days.     But  this  rule  was  found  in  many  cases  to  be  at  fault. 


-(Euvres  d'  Hippoc,  traDslated  by  E.  Littre,  Paris,  1840,  T.  II,  p.  169. 

f  See  page  83. 

I  See  the  Traite  de  la  Grossesse  a  sept  mois,  §  3 ;  translation  of  Gardeil. 

8 


122  PHILOSOPHIC    PERIOD. 

SO  that  they  were  forced  to  admit  that  the  rule  of  odd  days  was  excep- 
tional in  numerous  cases.  Hippocrates  himself  points  out  several.  In 
the  third  book  on  Epidemics,  section  third,  it  is  said  that  "  all  diseases 
offer,  it  is  true,  difl&culties  in  crises,  the  absence  of  crisis,  and  a  long 
duration,  which  was  especially  remarkable  in  those  to  which  I  refer :  in 
some,  the  crisis  was  retarded  for  eighty  days  ;  in  most  of  them  the  dis- 
ease ceased  without  a  distinct  crisis." 

Notwithstanding  the  vagueness  that  existed  in  the  determination  of 
critical  days,  the  doctrine  of  crisis  is  maintained  in  our  times.  Pinel, 
one  of  the  most  philosophic  spirits  of  our  epoch,  wrote  at  the  end  of  the 
last  century:  "I  suppose  that  no  one  is  so  little  enlightened,  as  to 
think  he  can  suspend,  by  the  aid  of  remedies,  the  course  of  an  acute 
disease,  such  as  an  essential  fever,  or  a  phlegmasia.  On  the  contrary, 
he  must  commence  by  counting  the  days,  from  the  beginning,  so  as  to 
recognise  what  their  actual  period  is.  It  is  known  that  inflammatory 
fevers,  as  well  as  gastric,  continue,  in  general,  to  the  end  of  the  first, 
second,  and  sometimes,  third  septenary  ;  but  the  gastric  remitting  fevers 
continue  to  the  sixth  or  seventh  week,  whatever  method  of  treatment 
may  be  employed,  and  may  continue  many  months,  if  exasperated  by  a 
too  active  treatment. =■■'" 

Landre  Beauvais,  author  of  a  treatise  on  Semeiotics,  expresses  himself 
as  follows:  "Hippocrates,  excellent  observer  and  reliable  historian, 
has  established  the  doctrine  of  crisis.  Asclepiades  and  the  methodists, 
guided  by  prejudice,  denied  the  crisis  and  critical  days.  They  accused 
Hippocrates  of  being  led  by  the  dogmas  of  Pythagoras,  or  numbers,  and 
they  attacked  Galen,  who  remained  faithful  to  the  principles  contained 
in  the  writings  of  the  father  of  medicine.  Asclepiades  had  many  imi- 
tators in  succeeding  ages  ;  Celsus  was  the  most  illustrious ;  but  can  one 
adopt  the  sentiments  of  those  who  refuse  to  admit  the  crisis,  when  it 
has  been  so  successfully  sustained  by  Galen,  Buret,  Baillou,  Fernel, 
Sydenham,  Forestus,  Stahl,  Baglivi,  Van  Swieten.  Stohl  and  Pinel,  and 
when  every  day,  clinical  observations  confirm  the  views  of  these  great 
masters,  "t 

A  medical  opinion  which  has  traversed  so  many  ages,  and  come  down 
to  us  supported  by  such  respectable  names,  merits  a  profound  examina- 
tion. We  must  conclude,  until  the  contrary  is  established,  that  it  is 
not  a  pure  play  'of  the  imagination,  but  that  it  has  some  foundation  in 
the  observation  of  the  natural  progress  of  diseases. 

I  will  remark,  in  the  first  place,  that  the  connection  that  exists  be- 


■'Nosogr.  Philos.  Introduction,  p.  35. 
f  Diction,  des  Scienc.  Medicales,  the  word  Crisis,  T.  11,  p.  376. 


SCHOOLS   OF  THE   ASCLEPIAD^.  123 

tween  the  doctrine  of  crisis  and  the  dogmas  of  Pythagoras — a  connec- 
tion that  it  is  vain  to  deny — proves  nothing  for  or  against  this  doctrine. 
The  real  question  is,  are  there  diseases  which  proceed,  or  seem  to  pro- 
ceed from  some  solid,  liquid,  er  gaseous,  deleterious  substance,  intro- 
duced into  the  economy,  exciting  there  a  reaction,  which  is  manifested 
by  a  succession  of  nearly  constant  symptoms  ?  I^ow  it  is  not  doubtful 
that  there  are  diseases  of  this  kind.  We  cite,  in  the  first  place,  fevers 
caused  by  vegetable  emanations — formerly  so  common,  and  so  destruc- 
tive, which  assume  usually,  a  periodic  form,  as  a  quotidian,  tertian  or 
quartan.  I  will  also  cite  the  eruptive  fevers,  such  as  variola,  rubeola, 
vaccinia,  miliary,  etc.,  which  have  well  marked  phases  of  incubation, 
eruption  and  desquemation.  It  ie  true,  that  certain  authors  pretend 
that  these  last  diseases  are  of  modern  origin — I  had  almost  said  inven- 
tion ;  but  that  is  a  controverted,  and  a  very  controvertible  opinion,  as  I 
shall  prove  at  a  proper  time.  But  admitting  they  are  so,  it  cannot  be 
denied  that  if  new  periodic  diseases  have  arisen  since  Hippocrates,  the 
old  ones  could  become  extinct,  and  in  this  hypothesis,  there  would  be, 
therefore,  a  compensation. 

Thus,  then,  there  has  existed,  and  there  still  exists  a  very  numerous 
class  of  diseases,  of  nearly  constant  periods,  and  it  is  in  a  great  measure, 
upon  the  observation  of  this  remarkable  phenomenon,  that  the  doctrine  of 
coction  and  crisis  has  been  founded.  Eecall  now  a  remark  that  I  have 
already  made,  namely,  that  the  attention  of  the  Asclepiadoe  was  especi- 
ally directed  to  acute  diseases,  and  amongst  these,  principally  to  epidem- 
ics. The  greater  number  of  the  clinical  relations  that  have  been  trans- 
mitted to  us,  relate  to  epidemics.  Now  febrile  affections,  of  regular 
periods,  generally  prevail  as  epidemics. 

What  then  is  the  reproach  that  can  be  legitimately  applied  to  Hippo- 
crates and  those  who  have  adopted  his  theory  of  crisis  ?  It  is  that  of 
extending  to  all  diseases  that  which  is  true  only  of  a  certain  number ; 
in  a  word,  for  having  generalised  too  much  an  idea ;  and  this  is  the 
most  common  defect  of  all  systems,  as  has  been  already  remarked. 


§  II.  Theory  of  the  Four  Elements  axd  the  Four  Humors. 

After  the  theory  of  coction  and  crisis,  that  which  prevails  the  most  in 
the  Hippocratic  books,  is  the  doctrine  of  the  four  elements,  or  the  four 
elementary  qualities,  heat,  cold,  dryness  and  moisture,  and  the  four  car- 
dinal humors,  blood,  bile,  atrabile  and  phlegm.  This  doctrine  was  sup- 
posed to  be  an  invention  of  the  father  of  Greek  medicine.  Such  is  the 
opinion  of  all  the  commentators  and  historiographers,  among  others 
Galen,  who  extended  and  perfected  it  in  his  manner,  and  it  reigned,  ex- 
clusively, after  him.     The  theory  of  four  elements  and  four  humors, 


124  PHILOSOPHIC   PERIOD. 

harmonizes  very  well  with  that  of  coction  and  crisis,  of  which  it  ap- 
pears to  be  the  complement. 

Empedocles,  of  Agrigentum,  who  has  been  mentioned  heretofore, 
was  the  first  who  introduced  into  physics,  the  consideration  of  four 
elementary  forms,  the  first  termed  terrestrial  or  solid,  the  second 
aqueous  or  liquid,  the  third  aerial  or  gaseous,  the  fourth  igneous  or  ethe- 
real. The  latter,  of  which  the  ancients  had  only  a  vague  notion,  cor- 
responds to  what  is  termed  an  imponderable  fluid,  in  modern  physics. 

Empedocles  admitted,  according  to  the  doctrine  of  his  master,  Pytha- 
goras, two  principles  in  every  thing :  the  one  active,  intelligent  and 
impalpable,  which  is  God ;  the  other  passive,  and  devoid  of  properties, 
having  no  definite  form,  but  susceptible  of  assuming  any  that  the  Crea- 
tor might  give  it,  named  amorphous  matter.  The  philosopher  of  Agri- 
gentum, conceived,  also,  that  amorphous  matter  had  received  from  the 
Supreme  Intelligence,  four  fundamental  or  elementary  modes  of  exist- 
ence, and  these  four  principal  modalities  of  matter,  variously  com- 
bined, constituted  all  the  bodies  in  nature ;  so  that,  according  to  this 
system,  there  is  no  material  substance  which  does  not  include  four  ele- 
ments, united  in  variable  proportions. 

The  element  which  constitutes  the  largest  proportion  in  a  body,  de- 
termines its  permanent  form  :  thus,  the  terrestial  element  predominates 
in  solids ;  the  aqueous  in  liquids  ;  the  aerial  in  vapours  or  gases  ;  the 
igneous  in  the  ether  or  imponderable  fluid.  In  this  way,  this  philoso- 
pher explained  the  varieties  of  bodies,  at  the  same  time  preserving  the 
Pythagorean  doctrine  of  homogenity  in  matter. 

The  assumption  of  four  elementary  or  primitive  forms  was  not,  as 
may  be  thought,  the  dream  of  an  exalted  imagination ;  the  attentive 
observation  of  some  very  remarkable  phenomena  had  suggested  the  idea, 
and  gave  it  the  appearance  of  reality ;  thus,  water  can  pass  from  a 
liquid  to  a  solid  or  gaseous  state,  without  changing  its  nature ;  so,  also, 
in  the  phenomenon  of  combustion,  the  wood,  especially  when  it  is  green, 
oozes  out  water  from  its  surface,  exhales  smoke,  which  the  ancients  re- 
garded as  crude  air,  deposits  ashes,  the  terrestrial  element,  and  lastly, 
gives  off  light  and  heat,  or  fire,  the  most  subtle  of  the  elements,  which 
ascends,  and  is  dissipated  in  the  ethereal  regions.  Here  the  chemical 
analysis  of  the  ancients  stopped. 

I  will  not  carry  farther  this  exposition  of  the  four  elements,  or  four 
primitive  forms  which  served  to  explain  the  infinite  diversity  of  the 
body  without  destroying  the  dogma  of  the  homogenity  of  matter.  It 
is  sufiicient  to  have  shown  that  it  was  neither  ridiculous  nor  absurd 
before  the  discoveries  of  modern  chemistry.  I  will  add  that  the  chem- 
ists themselves,  after  having  augmented  indefinitely  the  number  of  ele- 


SCHOOLS   OF  THE   ASCLEPIAD^.  125 

ments,  now  tend  to  limit  them,  and  are  not  far  from  returning  to  the 
dogma  of  the  homogenity  of  matter,  by  the  theory  of  equivalents.-' 

Such  was,  at  its  origin,  the  doctrine  of  the  four  elements,  which 
Plato  and  Aristotle  adopted,  and  sustained  by  new  and  extremely  sub- 
tle considerations,  as  we  shall  see  hereafter.  This  doctrine,  when  Hip- 
pocrates appeared,  had  all  the  force  and  attraction  of  freshness,  and  it 
is  not  astonishing  that  that  philosopher  made  it  the  basis  and  model  of 
his  medical  theory.  We  now  proceed  to  show  by  what  course  of  reason- 
ing he  was  led  to  it. 

He  commences  by  saying,  that  to  properly  understand  man,  it  is  neces- 
sary to  study  him  with  the  lights  of  Medicine,  ^.  e.,  in  a  state  of  health, 
and  disease.  He  refutes  the  opinion  of  the  philosophers  who  pretend 
that  man  is  formed  of  a  single  element,  and  relies  especially  upon  the 
little  accord  that  exists  among  them,  as  to  the  nature  of  that  unique 
element  —  some  affirming  that  it  is  air,  others  water,  others  fire,  and 
others  earth.  "  Now,"  says  he,  "  since  they  all  contend  for  the  same 
principle,  and  yet  all  come  to  diiferent  conclusions  about  it,  it  shows 
that  they  do  not  properly  understand  each  other." 

"  In  regard  to  physicians,"  he  adds,  "  some  contend  that  man  is  all 
blood,  others  that  he  is  all  bile,  others  all  phlegm,  and  some  all  gas. 
Each  one  adopts  the  same  mode  of  reasoning  ;  they  insist  that  the  being 
is  one,  whatever  name  may  be  given  to  it,  and  that  this  unique  substance 
changes  its  form  and  its  powers  accordingly  as  it  is  affected  by  heat  or 
cold.  As  for  my  views :  I  say,  that  if  man  were  a  simple  element  or 
being,  he  would  never  feel  pain  ;  for  what  could  excite  pain  in  him  if 
he  is  only  of  one  substance  ?  Suppose  that  he  was  susceptible  to  it :  the 
remedy  must  be  single  also  ;  but  we  know  that  there  are  various  reme- 
dies for  pain.  He  who  affirms  that  man  is  all  blood,  ought  to  show 
himself  unchangeable,  or  at  least,  he  should  assign  a  season,  or  an  epoch 
of  life,  in  which  we  can  see  in  man  nothing  but  blood ;  for  in  order  to 
be  sure  that  his  opinion  is  correct,  we  should  be  able  to  see,  at  some  time 
or  other,  at  least,  that  only  in  man  which  exclusively  constitutes  him, 
viz :  blood  ;  these  remarks  are  applicable  also  to  the  assertions  of  those 
who  pretend  that  he  is  all  bile  or  phlegm. 

"  At  first  the  generation  of  man  can  not  proceed  from  a  single  sub- 
stance, for  how  can  a  single  substance  be  developed  without  a  union 
with  something  else  ?  If  it  docs  not  mingle  with  other  different  beings, 
of  the  same  nature,  there  could  be  no  generation  of  an  economy  like 
ours.     Moreover  if  the  heat  and  cold,  the  dry  and  humid,  are  not  pro- 

'^  And  especially  is  this  further  illustrated  in  the  correllation  of  the  physical 
and  vital  forces. — Trans. 


126  PHILOSOPHIC  PERIOD. 

perly  tempered  together,  if  one  predominates  too  much,  the  generation 
could  not  take  place.  In  like  manner  when  a  man  dies,  each  of  the 
elements  of  which  he  is  composed  takes  a  different  direction,  according 
to  its  nature  —  the  humid  to  the  humid,  the  dry  to  the  dry,  the  heat 
to  the  heat,  and  the  cold  to  the  cold. 

"  The  human  body  contains  blood,  phlegm,  and  two  sorts  of  bile,  yel- 
low and  black.  Such  is  its  nature,  and  their  condition  determines  the 
state  of  health.  It  is  healthy  when  each  of  these  fluids  is  in  due  pro- 
portion to  the  other  as  to  quantity  and  character,  and  especially  when 
they  are  well  mixed  ;  it  is  diseased  when  any  one  is  in  excess,  or  lacks 
its  due  proportion  to  the  rest,  or  is  evacuated  without  being  properly 
mixed  —  for  when  it  is  thus  evacuated,  not  only  the  region  where  the 
admixture  should  take  place  must  be  affected,  but  still  more,  the  organ 
through  which  it  passes  off,  becomes  surcharged  and  suffers  painful 
struggles. 

"  I  have  said  that  I  would  show  that  the  things  of  which  man  is 
composed  always  remain  the  same.  This  is  generally  admitted,  and  is 
proved  by  the  examination  of  his  nature.  Now  the  blood,  phlegm, 
yellow  or  black  bile,  by  common  consent,  are  always  the  same,  for  neither 
of  these  words  has  an  equivocal  or  doubtful  meaning.  Again,  these 
elements  are  very  distinct  in  their  nature  ;  the  phlegm  has  no  resem- 
blance to  the  blood,  nor  the  blood  to  the  bile,  nor  the  bile  to  the  phlegm. 
How  then  can  they  be  confounded  ?  —  for  these  differences  are  recog- 
nized by  the  sight  alone,  as  they  differ  very  much  in  color.  So,  if  they 
are  touched,  there  are  manifest  differences  in  the  sensations  they  impart. 
So  also,  are  they  unlike  in  temperature  and  consistence.  If  a  remedy 
is  taken  that  acts  on  the  phlegm,  it  is  phlegm  that  is  discharged  ;  if  it 
acts  on  the  bile,  that  is  cast  off ;  or  if  the  body  is  wounded,  it  is  blood 
that  flows  out.  These  results  occur  at  all  seasons,  all  periods  of  life, 
and  at  all  times.  Thus  man  is  really  constituted  of  four  humors,  which 
are  manifest  to  our  senses,  and  there  is  no  need  of  special  arguments  to 
prove  it."  =•■■= 

The  author,  after  having  established  his  doctrine  by  unquestionable 
arguments  and  observations,  and  having  refuted  the  objections  of  those 
who  professed  contrary  views,  continues  thus  the  exposition  of  his 
own :  "  The  phlegm  augments  in  man  during  the  winter,  and  this 
humor  is  more  analogous  in  its  nature  to  that  season ;  for  it  is  the 
coldest  of  all,  as  can  be  readily  proved.  If  the  phlegm,  blood,  and  bile, 
are  touched  successively,  it  will  be  found  that  the  first  is  the  coldest. 
In  the  spring  the  blood  augments  ;  for  there  is  an  affinity  in  its  nature 

*-'  De  la  Nature  de  I'Homme ;  Gardeil. 


SCHOOLS   OF  THE   ASCLEPIAD^.  127 

with  the  constitution  of  that  part  of  the  year  —  it  is  hot  and  moist. 
The  bile  increases  in  summer  for  the  same  reason,  and  the  atrabile 
becomes  most  abundant  and  strongest  in  autumn." 

Hippocrates  then  explains  summarily,  how  diseases  are  engendered, 
namely,  by  the  influence  of  the  seasons,  or  by  the  regimen,  the  tem- 
perament, or  the  air  that  is  breathed.  Finally,  ho  establishes  a  general 
rule  for  their  cures,  which  consist,  according  to  him,  in  inducing  action 
in  the  system  contrary  to  that  produced  by  the  cause  of  the  diseases. 

AYhatever  view  may  be  formed  of  this  system,  comparing  it  with  our 
present  knowledge,  we  are  forced  to  admit  that  united  to  the  doctrine  of 
coction  and  crisis,  with  which  it  perfectly  afiiliates,  it  offers  an  interpre- 
tation, sufliciently  reasonable,  of  the  physiological  phenomena  which  had 
attracted  the  attention  of  the  observers  of  that  epoch.  In  fact,  all 
phenomena,  of  whatever  character,  can  only  result  from  the  combined 
action  of  vital  and  physico-chemical  forces,  that  act  similtaneously  on 
the  animal  economy.  Now,  the  theory  of  coction  explains  the  laws  by 
which  the  vital  principle  is  supposed  to  exercise  its  influence  ;  that  on 
the  elements  and  humors  exhibits  the  influence  of  the  inorganic  forces, 
and  the  laws  according  to  which  that  influence  is  applied  to  organized 
bodies. 

These  two  theories  united,  constitute  the  ancient  Dogmatism  —  a 
doctrine  originally  of  the  school  of  Cos,  and  of  which  Hippocrates  is 
regarded  as  the  principal  author.  In  that  doctrine  the  humors  play 
the  part  of  secondary  or  physiological  elements ;  they  are  agents  en- 
dowed with  diverse,  or  even  contrary  properties,  placed  at  the  disposal 
of  the  vital  principle,  which  alone  gives  to  them  a  good  or  evil  direction. 
But  these  agents  can  contract,  sometimes,  deleterious  properties,  in  con- 
sequence of  external  forces  not  controlled  by  the  vital  principle. 

The  external  forces  admitted  by  the  ancients,  as  we  have  seen,  are  of 
four  kinds,  heat,  cold,  dryness,  and  moisture,  which  may  be  easily 
reduced  to  two  by  the  augmentation  or  diminution  of  caloric  and  mois- 
ture. This  shows  the  poverty  of  the  physics  and  chemistry  of  the 
ancients.  They  had  no  idea  either  of  atmospheric  pressure  or  its  com- 
position ;  neither  of  electricity,  the  chemical  phenomena  of  respiration, 
nor  a  multitude  of  other  phenomena  and  influences.  They  possessed 
even  on  the  efi'ects  of  caloric  and  moisture,  but  vague  and  super- 
ficial perceptions,  and  considered  their  actions  only  in  relation  to  the 
humors  of  the  human  body,  without  taking  any  account  of  the  not  less 
important  modifications  which  they  produce  upon  the  solids.  Besides, 
they  attributed  to  the  humors  imaginary  qualities,  derived  from  the 
elements  that  were  supposed  to  predominate  in  their  composition.     They 


128  PHILOSOPHIC    PERIOD. 

also  conceived  relations  to  exist  between  these  humors  and  the  seasons 
of  the  year,  which  were  more  poetic  than  real. 

The  Asclepiadse,  imbued  with  the  same  dogmas  as  Pythagoras,  believed 
in  a  perfect  harmony  between  the  universe,  or  the  macrocosm,  and  man, 
or  the  microcosm.  For  this  reason  they  admitted  four  humors  in  their 
physiology,  though  observation  could  only  distinctly  demonstrate  three — 
the  blood,  bile,  and  phlegm.  The  fourth  humor  was  an  object  of  much 
uncertainty  and  obscurity,  among  the  Hippocratic  authors.  Some  assimi- 
lated it  to  the  terrestrial  element,  and  called  it  atrabile,  attributing 
to  it  extremely  active  properties,  and  regarding  it  ttS  the  cause  of  the 
gravest  affections  ;  others  assimilated  it  to  the  liquid  element,  gave  it 
the  nameof  water,  and  regarded  it  nearly  as  a  nullity,  in  the  produc- 
tion of  diseases.  It  was  said,  by  one :  the  heart  is  the  reservoir  of  the 
blood,  the  head  of  the  phlegm,  the  liver  of  the  bile,  and  the  spleen  of 
the  water. 

If  the  physicians  had  been  less  subjected  to  their  philosophic  pre- 
judices, and  relied  more  upon  observation,  they  would  have  been  able 
to  discover  more  reasonable  relations  between  the  humors  of  the  body 
and  the  seasons  of  the  year  ;  they  would  have  found,  for  example,  that 
the  prolonged  action  of  cold,  damp  weather,  at  the  close  of  autumn  and 
the  commencement  of  winter,  in  the  temperate  climate  of  Greece,  devel- 
oped the  lymphatic  or  pituitary  temperament  and  humor,  as  well  as 
catarrhal  affections  ;  that  the  damp,  warm  constitution  of  the  weather  at 
the  end  of  winter,  and  in  spring,  disposed  to  open  inflammatory  diseases 
and  hemorrhages  ;  and  lastly,  that  the  dry  heat  of  summer  and  the 
beginning  of  autumn,  increased  the  secretion  of  bile,  and  favored  the 
prevalence  of  inflammatory  bilious  and  putrid  bilious  fevers  ;  but  to 
see  this  they  would  have  had  to  renounce  the  Pythogorian  harmony  of 
the  four  humors  with  the  four  elements  and  four  seasons. 

Notwithstanding  its  errors  and  imperfections,  the  doctrine  of  Dogma- 
tism is  the  most  ingenious  and  the  most  complete  of  all  the  medical 
doctrines  of  antiquity  ;  it  responds  better  than  any  other  to  the  wants 
and  tendencies  of  antique  science,  and  it  was  received  and  adopted 
with  admiration,  not  only  by  the  generality  of  physicians,  but  also  by 
the  greatest  philosophers.  We  shall  have  occasion  to  speak  of  it  more 
than  once,  in  considering  the  modifications  it  has  undergone  in  its  long 
reign. 

What  shall  be  said  now  of  those  who  attributed  to  Hippocrates  the 
glory  of  having  separated  Medicine  from  philosophy ;  and  of  those,  on 
the  contrary,  who  attributed  to  him  the  glory  of  uniting  philosophy 
with  Medicine  ?     It  must  be  said  of  them,  wliat  Hippocrates  says  of 


SCHOOLS   OF  THE   ASCLEPIAD^.  129 

those  Tvho  saw  only  one  element  in  man :  they  do  not  well  understand 
themselves. 

It  is  certain  that  Medicine  had  been  philosophized  upon  before  Hip- 
pocrates ;  it  is  also  equally  certain  that  Hippocrates  philosophized  as 
others,  and  that  he  shared  the  prejudices  of  his  age  in  many  particulars  ; 
but  in  some  respects  his  philosophy  is  distinguished  from  that  of  his 
cotemporaries  by  great'^r  and  more  profound  wisdom.  He  reminds  the 
philosophers  and  physicians,  continually,  of  the  maxim  too  often  neg- 
lected by  them,  and  even  by  himself,  that  the  nature  of  man  can  not  he 
well  known  without  the  aid  of  medical  observation,  and  that  nothing  should 
be  affirmed  concerning  thai  nature,  until  after  having  acquired  a  cer- 
tainty of  it,  by  the  aid  of  the  senses  ;  a  maxim  diametrically  opposed  to 
the  dogmas  of  Pythagoras,  and  which  includes  the  germ  of  an  entirely 
new  philosophy,  that  Plato  misconceived,  and  of  which  Aristotle  had 
only  a  glimpse,  as  I  shall  show  hereafter. 

The  other  theories  that  are  found  in  the  Hippocratic  collection,  have 
not  now  the  importance  of  the  two  preceeding  ;  they  are  only  met  with 
in  a  small  number  of  works,  sometimes  in  one  alone.  They  were  never 
adopted  by  a  large  number  of  physicians,  and  must  be  considered  as 
the  individual  or  particular  opinions  of  some  writers.  A  few  of  them, 
however,  have  furnished  the  first  suggestions  of  the  great  systems  in- 
vented at  later  periods,  and  on  this  account  they  merit  special  atten- 
tion ;  for  they  show  us  the  origin  and  connection  of  the  prevalent  ideas 
of  past  ages. 


§  III.  Theoey  of  Fluxions. 

This  theory,  one  of  the  most  simple  that  can  be  imagined,  is  regarded 
as  being  anterior  to  Hippocrates.  It  is  predominant  in  two  treatises, 
viz.,  those  on  the  Eegions  in  Man,  and  on  the  Glands.  A  few  extracts 
from  these  two  books  will  give  us  a  sufficient  idea  of  the  doctrine. 

It  is  said  in  the  first,  "  Fluxions  are  caused  by  cold,  which  causes  the 
condensation  of  the  tissues  and  veins  of  the  head,  if  the  cold  strikes 
them  when  they  are  heated ;  then  by  their  contraction  the  humors  con- 
tained in  them  are  expelled.  All  the  tissues  are  obliged  to  pour  out 
their  fluids  when  they  contract.  The  contraction  of  the  skin,  by  com- 
pressing the  roots  of  the  hairs,  causes  them  to  become  erect.  The 
liquids  thus  compressed  are  diffused  in  every  possible  direction. 

"  Fluxions  are  also  caused  by  heat,  because  the  tissues  become  rarified 
when  they  are  heated,  their  pores  enlarge,  and  the  humor  they  contain 
is  attenuated,  so  that  it  flows  easily  when  compressed.     The  greater  the 


130  PHILOSOPHIC   PERIOD. 

rarification,  the  more  the  eiFusion,  especially  when  the  tissues  are  full  of 
humors  ;  what  they  can  no  longer  contain,  escapes.  When  a  channel  is 
once  formed,  they  pass  off  by  it  until  the  body,  becoming  dry,  contracts 
and  closes  the  passage.  As  all  parts  are  in  communication,  the  moisture 
that  exists  is  attracted  by  the  dryest.  The  body  being  permeable,  it  is 
easy,  in  those  parts  which  have  not  imbibed  so  as  to  augment  their  vol- 
ume, to  attract  the  humors ;  especially  is  this  the  case,  if  the  inferior 
extremities  are  dry,  the  superior  being  charged  with  humidity  ;  for  there 
are  more  veins  in  the  upper  part  of  the  body,  than  in  the  lower,  and  the 
soft  parts  of  the  head  are  thinner,  and  need  less  humidity.  The  fluxion 
in  this  way  becomes  easy  from  the  moist  parts  toward  the  dry ;  beside 
this,  all  the  dry  parts  attract  moisture.  Nor  can  it  be  denied,  that  the 
humors  tend  downward,  naturally,  however  light  the  force  may  be  that 
affects  them." 

It  would  be  difficult  to  exhibit,  in  so  few  words,  more  ignorance  on  the 
conformation  of  our  tissues,  and  the  laws  of  physiology  and  physics.  It 
will  not  be  expected  that  I  should  seriously  attempt  to  refute  the  gross 
errors  that  are  crowded  together  in  these  few  lines.  I  will  simply  say, 
that  the  body  of  man  is  there  likened,  sometimes  to  a  sponge,  which 
absorbs  water  or  allows  it  to  escape,  according  to  the  degree  of  pressure 
acting  upon  it;  sometimes  to  a  sieve,  the  pores  of  which  are  dilated  by 
heat,  giving  a  free  passage  to  the  fluids,  or  contracted  by  cold,  and  pre- 
venting their  passage.  There  is  no  more  mention  of  the  organic  or  vital 
forces,  the  effects  of  which  are  so  manifest  and  wonderful,  not  only  in 
the  human  economy,  but  also  in  the  vegetable,  than  if  they  did  not 
exist  at  all ! 

The  author  of  this  book  admits  seven  species  of  fluxions :  the  first 
tends  to  the  eyes ;  the  second  to  the  nose ;  the  third  to  the  ears  ;  the  fourth 
to  the  chest ;  the  fifth  to  the  spinal  marrow ;  the  sixth  to  the  vertebra 
and  general  tissues ;  finally,  the  seventh,  which  flows  slower  than  any 
other,  producing  sciatica  and  rheumatism.  In  this  way  he  explains  the 
origin  of  all  diseases. 

As  to  the  treatment,  it  is  worthy  of  such  an  etiology.  I  will  quote 
only  one  method,  which  will  be  sufficient  to  give  an  idea  of  others.  "  To 
cure  convulsions  it  is  necessary  to  place  a  furnace  of  coals  on  each  side 
of  the  bed,  and  give  an  infusion  of  the  root  of  mandrake,  but  not  so 
strong  as  to  excite  frenzy,  and  apply  hot  cloths  to  the  ligamentum 
nuchoe."  The  translators  and  commentators  are  much  at  a  loss  to  find 
any  common  sense  in  this  passage,  because  the  curative  method  laid 
down  is  so  absurd ;  but  they  omit  to  notice,  that  that  method  proceeds, 
naturally,  from  the  etiology  above  given.     In  fact,  if  convulsions  result 


SCHOOLS   OF  THE   ASCLEPIADiE.  131 

from  too  much  humidity  in  the  head,  it  is  entii-ely  natural  that  an 
effort  should  be  made  to  diminish  this  excess  of  humor,  by  a  large  sup- 
ply of  heated  furnaces  and  hot  bags. 

I  will  complete  the  exposition  of  this  theory,  by  some  extracts  from  a 
little  monograph  on  the  glands.  The  author  commences  thus:  "The 
structure  of  the  glands  is  such  as  I  have  just  stated.  They  are  of  a 
loose,  spongy  nature,  and  of  a  fatty  color.  Their  tissue  is  not  like  that 
of  other  parts  of  the  body,  and  may  be  distinguished  from  all  other 
parts  by  being  granular.  They  have  many  veins.  When  they  are  cut, 
the  blood  that  flows  out  is  whitish  and  watery.  When  handled,  they 
feel  like  greasy  wool,  and  if  strongly  pressed  between  the  fingers,  a  juice 
oozes  out,  which  looks  somewhat  like  oil,  and  their  organization  is 
destroyed. 

'•  The  glands  are  found  in  great  numbers  in  the  interior  of  the  body: 
more  numerous  in  the  cavities  than  around  the  articulations.  They  are. 
also,  found  in  all  moist  and  sanguineous  regions.  Some  attract  and 
take  up  the  humors  that  come  from  above,  into  the  cavities,  others  absorb 
those  which  are  poured  out  in  large  quantities  in  the  cavities  themselves, 
or  those  which  are  expressed  by  the  working  of  the  joints.  Thus  they 
prevent  the  superabundance  of  humors  in  the  tissues.  Observe  too, 
that  where  there  is  hair,  there  are  glands  also.  There  is  a  connection 
between  the  hair  and  the  glands ;  these  attract  the  humors,  as  above 
said ;  the  hair  profits  by  it :  it  is  developed  by  the  nourishment  which 
the  glands  procure,  and  grows  by  leading  outward  the  excess  of  humors. 
In  dry  parts  of  the  body  we  see  neither  hair  nor  glands." 

A  little  further  on,  the  author  observes,  that  certain  parts,  as  the 
intestines  and  the  omentum,  have  glands,  but  no  hair,  but  he  is  not 
embarrassed  to  explain  this  anomaly.  "We  see,"  he  says,  "that  in 
marshes  and  very  wet  places,  the  seeds  do  not  germinate ;  they  perish, 
smothered  by  excess  of  moisture.  So  in  the  intestines,  the  abundance 
of  fluids  prevents  the  development  of  glands,  and  there  is,  therefore,  no 
hair." 

These  efforts  to  explain  everything,  often  throws  the  best  minds  into 
strange  ramblings.  We  shall  see  many,  and  even  celebrated  examples 
of  it.  The  philosophers  and  physicians  of  antiquity  would  have 
thought  themselves  without  reputation,  if  they  had  announced  a  single 
phenomenon  without  giving  some  interpretation  of  it.  Eather  than  fail 
in  this,  they  made  use  of  the  most  ridiculous  explanations.  The  little 
treatise  that  suggests  these  reflections  is  certainly  not  one  of  the  worst 
executed  of  the  Hippocratic  collection  ;  it  exhibits  its  subject,  on  the 
contrary,  with  all  the  details  and  comprehensiveness  that  the  anatom- 
ical light  of  that  epoch  would  allow,  yet  what  vagaries  it  contains  ! 


132  PHILOSOPHIC  PERIOD. 

One  example  more,  and  the  last:  "  The  head  has  glands ;  the  brain 
itself  resembles  a  gland,  it  is  white,  and  divided  into  lobes,  like  glands. 
It  produces,  also,  the  same  effects,  abstracting  from  the  head,  as  before 
said,  the  humors  which  there  abound.  The  brain  relieves  the  head 
from  humors,  and  distributes  them  to  the  extremities,  by  means  of  cur- 
rents that  flow  in  different  parts.  Observe,  also,  that  the  brain  is  larger 
than  the  glands.^-''     The  hair  on  the  head  is  longer  than  elsewhere. 

It  is  from  the  continued  flow  of  the  humors  toward  the  head,  which  can 
not  contain  them,  as  well  as  from  their  unceasing  currents  toward  the 
parts  which  need  them  for  their  nutrition,  that  proceed  the  alteration 
of  humors,  and  thus  diseases.  Either  of  these  results,  if  not  checked, 
may  exhaust  nature  entirely,  although  there  are  great  differences  in  the 
intensity  of  diseases." 


§  IV.    Theories  Founded  on  the  Consideration  of  Two  Elements. 

The  four  elementary  forms  of  matter  described  in  the  chapter  before 
the  last,  are  so  well  determined,  and  so  constantly  referred  to  in  all 
these  works,  that  it  would  be  impossible  to  mistake  them ;  beside,  no 
ancient  author  has  attempted  to  deny  their  existence ;  but  some  have 
assumed  that  only  two  of  them  are  primitive  elements,  or  even  one 
alone,  the  others  being  regarded  as  secondary. 

I.  In  the  little  treatise,  entitled,  "  On  Fleshes,  or  the  Origin 
of  Man,"  fire  and  earth  alone,  are  designated  as  elements.  Fire  is 
the  active  principle,  which  the  author  supposes  to  be  endowed  with 
intelligence,  wisdom,  and  will ;  he  confounds  it  with  the  soul  of  the 
world,  or  God.  The  earth  is  the  passive  principle ;  it  receives,  by  the 
action  of  fire,  or  its  mixture  with  it,  all  the  apparent  forms  of  the  body. 
The  physiology  developed  in  this  book  is  very  odd,  as  the  following 
extracts  show: 

"  I  think  that  what  we  have  called  heat  is  immortal,  that  it  knows, 
sees,  and  understands  all  things  in  the  past  and  in  the  future.  When 
all  things  were  created,  it  was  developed  in  lai-ger  quantities  in  the 
upper  regions.  The  ancients,  I  believe,  gave  it  the  name  of  ether.  The 
other  element,  which  remained  below,  is  called  the  earth  ;  it  is  cold,  dry, 
in  active  motion,  and  contains  much  heat.  The  third  part,  which  is 
located  in  mid-air,  is  somewhat  warm  ;  the  fourth,  which  is  nearest  the 
earth,  is  damp  and  crude.     After  all  had  been  impressed  with  a  circular 

'  The  author  does  not  include  the  liver  among  the  glands. 


SCHOOLS   OF  THE   ASCLEPIAD^.  133 

motion^  they  became  mingled,  and  much  more  heat  accumulated  in 
some  parts  of  the  earth  than  in  others.  The  quantity  was  consider- 
able, but  the  volume  was  small." 

"  The  earth,  after  a  long  time,  becoming  dry,  a  mould  was  found  on 
it,  as  is  often  on  old  clothes ;  and  after  another  very  long  lapse  of  time, 
what  there  was  of  fat  and  moisture  in  this  mould,  proceeding  from  the 
earth,  being  at  last  burned,  formed  bones. 

"  That  which  was  sticky,  and  contained  the  cold  element,  could  not 
bum,  though  made  hot,  nor  become  moist.  It  then  took  a  form  differ- 
ent from  the  rest,  and  was  developed  into  solid  nerves,  for  there  was  no 
cold  in  them. 

"  The  veins  required  much  of  the  cold  element.  The  exterior  part  of 
this  element,  acted  upon  by  the  heat,  formed  a  dense  envelope  and 
became  a  membrane.  The  interior  of  the  veins,  melted  by  the  heat, 
became  liquid. 

"  In  this  way,  in  man  and  in  other  animals,  the  wind-pipe,  the 
stomach,  the  abdomen,  and  intestines,  all  became  hollow. 

"  The  cold  element  continually  growing  warmer,  the  exterior  was 
burned  and  became  an  envelope  or  membrane ;  the  interior  cold  that 
existed;  being  neither  fatty  nor  viscous,  became  humid,  and  was  changed 
into  a  liquid."- 

The  author  explains,  after  the  same  manner,  the  formation  of  all  the 
structures  of  the  human  body,  their  nature,  nutrition,  and  various 
functions. 

"The  brain,"  he  says,  "is  the  center  of  the  cold  element;  the  fat. 
that  of  heat. 

"  The  veins  that  come  from  the  belly  and  the  intestines,  continually 
attract  or  absorb  what  is  thinnest,  and  most  liquid  in  the  food  and 
drinks.  After  the  mixture  has  become  heated,  the  grossest  remains  and 
becomes  excrement,  and  passes  to  the  large  intestine.  The  nutritive 
substance,  reaching  the  various  tissues,  is  distributed,  furnishing  to  each 
what  is  to  be  permanent  of  its  structure.  These  tissues,  moistened  by 
the  nutritious  juice,  all  grow  by  the  hot,  cold,  viscous,  fatty,  sweet,  and 
bitter  elements. 

II.  The  treatise  on  regimen,  of  which  we  have  spoken  in  our  article 
on  hygiene,  includes  a  doctrine  which  is  very  analogous  to  the  preceding, 
but  differs  from  it,  in  that  water  takes  the  place  of  earth,  and  is 
a  passive  element.  The  author  commences  by  discussing  the  prelimi- 
nary knowledge  necessary  to  write  well,  on  the  regimen  of  man,  and 
places  in  the  first  rank  the  knowledge  of  the  human  nature,  of  its 

~  Traite  des  chairs,  ou  du  commencement  de  I'homme,  §§  2,  3, 4,  5, 6,  7.  Gardeil. 


134  PHILOSOPHIC   PERIOD. 

origin,  and  the  parts  or  elements  that  concur  to  form  it.  "If,"  he 
says,  "  a  physician  is  ignorant  of  what  man  is  made  at  first,  and  what 
predominates  in  him,  how  can  he  prescribe  what  may  be  useful  to  him." 
After  these  general  physiological  considerations,  on  which  he  dilates  at 
large,  he  enters  into  his  subject-matter  as  follows  :  "  Man  and  all 
animals  combine,  each  in  themselves,  two  principles,  very  different  in 
regard  to  their  relative  powers,  but  which  concur  for  various  purposes : 
namely,  fire  and  water.  These  two  principles,  alone,  are  sufiicient  to 
act  on  all  the  rest,  and  to  maintain  the  general  movements.  One  with- 
out the  other  would  not  be  sufficient  for  the  animal  economy,  nor  any 
other  being.  Now  I  will  state  the  powers  of  each.  Fire  is  the  source 
of  all  motion,  and  water  of  all  nutrition.  Each  one  possesses  certain 
necessary  qualities ;  fire  is  hot  and  dry,  water,  cold  and  moist.  They 
borrow,  also,  qualities  from  each  other ;  fire  borrows  from  water,  humid- 
ity, for  there  is  in  fire  a  humidity  that  comes  from  water ;  water  bor- 
rows from  fire,  di-yness,  for  there  is  a  dryness  in  water  that  comes  from 
fire. 

"  Nothing  is  entirely  lost,  and  nothing  new  is  made ;  only  different 
combinations  are  formed.  Men  think  that  what  is  born  comes  from  a 
state  of  death,  and  what  disappears,  perishes,  and  that  it  is  necessary  to 
rely  more,  in  this  matter,  upon  the  senses  than  upon  reason,  in  which 
they  are  wrong.  Listen  to  reason !  "  The  author  then  enlarges  upon 
this  beautiful  thought,  but  only  spoils  it  by  a  miserable  concoction  of 
physics  and  metaphysics. 

At  last,  he  comes  to  the  generation  of  man,  which  he  explains  as  fol- 
lows :  "  The  mixture  of  semen  is  vitalized  by  agitation,  and  it  draws  its 
nourishment  partly  from  different  aliments,  and  partly  from  the  air  that 
penetrates  the  body  of  the  woman.  At  first,  the  mixture  is  entirely 
homogeneous,  but  becomes  swollen  and  rarified.  It  is  next  dried  by  the 
action  of  heat,  which  renders  it  firm,  and  consumes  its  internal  humi- 
dity. That  which  is  more  firm  in  its  nature,  becomes  compact  and  dry, 
and  still  being  acted  upon  by  heat,  it  hardens,  and  forms  what  are 
called  bones  and  ligaments.  Fire  thus  effects  all  the  changes  in  the 
body,  according  to  the  structure  of  each  part,  by  means  of  its  effects 
upon  moisture." 

With  this  somewhat  fantastic  anthropogeny,  the  author  attempts  to 
show  connections,  not  less  curious,  between  vital  and  astral  heat.  The 
teat  of  the  abdomen,  which  he  terms  the  cavity  of  humidity,  is,  accord- 
ing to  him,  under  the  influence  of  the  moon:  the  heat  which  goes  to 
the  surface  of  the  body,  to  the  fleshes,  (tissues) ,  is  similar  to  that  of  the 
stars ;  finally,  the  central  heat  of  the  body,  which  is  carried  by  the  vessels 
from  within  outward,  is  the  most  potent  of  all ;  it  exerts  an  influence 


SCHOOLS  OF  THE  ASCLEPIADiG.  135 

analogous  to  that  of  the  sun.  "  It  is,"  continues  our  physiologist, 
"  this  central  fire  which  directs  every  thing,  according  to  the  laws  of 
nature,  in  an  unseen,  intangible,  and  noiseless  manner.  In  it  resides 
the  soul,  the  intelligence,  prudence,  augmentation,  motion,  diminution, 
alternation,  sleep,  and  wakefulness.  It  governs  all  things,  every  where, 
and  at  all  times ;  being  never  in  repose." 

After  making  so  poor  an  application  of  astronomical  knowledge,  he 
next  passes  in  review,  the  most  common  occupations  of  life,  such  as  melt- 
ing of  metals,  fulling,  shoemaking,  woodsawing,  architecture,  music, 
and  divining.  He  finds  that  each  of  these  offers  an  imitation  of  the 
regimen  of  man — a  similitude  with  certain  acts  of  the  economy.  For 
example,  in  speaking  of  goldsmiths,  he  says,  "  the  goldsmith  washes  the 
gold,  beats,  and  melts  it  in  a  moderate  fire.  Intense  heat  is  not  best 
adapted  to  it.  After  being  thus  prepared,  he  employs  it  for  every  pur- 
pose. So  man  gathers  wheat,  washes,  grinds  and  bakes  it,  and  employs 
it  for  food,  without  using  intense  heat.  It  is  submitted  during  diges- 
tion, to  a  notable  change,  by  the  mild  heat  of  the  body." 

When  Empedocles  reduced  the  primitive  forms  of  matter  to  four ; 
when  Hippocrates  put  forth  his  beautiful  theory  of  coction  and  crisis, 
they  both  started  on  correct  observations,  both  rested  on  the  real  rela- 
tions, that  a  wise  analysis  had  revealed  to  them ;  whilst  the  inventors 
of  the  two  theories  that  we  have  just  read,  have  established  their  syn- 
theses, on  false  or  trivial  bases  only,  and  by  forced  relations.  They 
were  anxious  to  invent  something  new,  but  have  only  succeeded  in  the 
hypothetical  and  ridiculous.  It  would  have  been  much  better  to  have 
followed  the  already  beaten  track,  thar.  the  vagaries  of  a  wild  imagination. 

III.  To  the  physico-physiological  systems,  in  which  only  two  genera- 
tive principles  are  allowed  for  the  whole  body,  responds  the  pathologi- 
cal theory,  according  to  which  all  diseases  are  supposed  to  proceed  from 
two  humors  only.  This  last  predominates  in  the  two  principal  treatises 
on  pathology,  in  the  Hippocratic  collection  ;  but  it  is  not  pure,  and  ex- 
empt from  admixture,  for  we  see  in  them,  also,  the  doctrine  of  four  hu- 
mors. The  following  is  in  substance,  what  we  read  in  one  of  these  trea- 
tises: "all  diseases,  if  they  are  internal,  proceed  from  the  bile  or 
phlegm ;  if  they  are  external,  from  various  accidents — such  as  excessive 
heat  or  cold,  dryness  or  humidity.  Melancholy,  produced  by  black  bile, 
causes  paralysis. '"  A  little  farther  on,  we  read,  •'  those  whom  atrabile 
torments  become  diseased  whenever  the  blood  is  overcharged  by  bile  and 
phlegm.'*f 


~'  Traite  des  Maladies,  livre  premiere,  Gardeil. 
flbid. 


136  PHILOSOPHIC   PERIOD. 

The  second  treatise  on  pathology,  in  which  the  theory  of  two  humors 
reigns,  is  entitled  "  on  Affections''  In  this,  we  find  the  same  mixture  of 
doctrines  above  stated,  as  may  be  seen  by  reading  only  paragraphs  1 
and  36. 


§  V.  Theory  of  Onk  Single  Element. 

The  physiologists  who  see  in  the  animal  economy  only  one  element, 
do  not  pretend  to  say,  by  this,  that  man  is  formed  of  a  unique  substance, 
diversely  modified,  but  they  wish  to  inculcate,  that  among  the  elements 
that  enter  into  the  constitution  of  man.  there  is  one  which  predominates 
over  the  rest,  by  its  energy  or  its  activity,  and  concurs  in  a  preponderat- 
ing, if  not  exclusive  manner,  to  the  production  of  physiological  and 
pathological  phenomena.  To  establish  the  unity  of  the  active  forces 
of  nature,  has  been  the  dream  of  many  physiologists  and  physicians  ; 
but  up  to  this  time,  all  the  hypotheses  conceived  to  this  euu,  have  been 
Utopian. 

The  Hippocratic  collection  includes  two  books  in  which  the  doctrine 
of  a  "  single  element  "  reigns.  One,  a  treatise  on  embryology,  is  en- 
titled, "  on  the  Nature  of  the  Child,"  and  is  well  executed  and  complete 
enough  for  that  epoch.  It  seems  to  be  the  conclusion  of  the  book  on 
Generation.  The  other  is  a  very  short  treatise  on  general  pathology, 
which  has  for  a  title,  "  On  Air."  The  air,  breath,  or  as  the  Greeks  call 
it,  pneuma,  plays  the  principal  part  in  the  two  treatises,  but  its  influ- 
ence is  considered  in  a  much  less  clear  and  exclusive  manner  in  the  first 
than  in  the  second. 

We  read  in  the  latter  as  follows :  "An  important  thing  to  discover, 
is  the  cause  of  diseases  —  the  origin,  the  source  of  the  evils  that  are 
engendered  in  the  body.  "Whoever  can  comprehend  the  cause  of  a  dis- 
ease will  be  capable  of  curing  it,  by  employing  a  remedy  which  is  the 
opposite  of  the  evil  from  its  commencement." 

After  having  shown  the  necessity  of  going  back  to  the  cause  of  dis- 
eases, to  efi"ect  their  cure,  the  author  continues  i-hus  :  "  The  nature  of 
all  afi'ections  is  the  same  ;  they  difier  only  in  relation  to  their  seat.  I 
think  that  they  only  show  themselves  under  so  many  different  forms  on 
account  of  the  great  diversity  of  parts  where  the  disease  is  located. 
Their  essence  is  one,  and  so  is  the  cause  that  produces  them.  But  what 
is  this  cause  ?     This  is  what  I  will  endeavor  to  explain." 

"  The  body  of  man  is  nourished  by  three  things  —  food,  drink,  and 
air  ;  he  eats,  drinks,  and  breathes.  The  air  in  the  body  is  called  spirit, 
or  breath  ;  that  external  to  the  body  is  called  wind.  It  is  the  breath 
that  produces  the  greatest  phenomena,  and  its  influence  merits  all  our 


SCHOOLS   OF   THE    ASCLEPIAD^.  137 

attention.  Nothing  can  be  done  without  air  ;  it  is  everywhere  present ; 
it  fills  the  immense  interval  that  separates  the  earth  from  the  heavens  ; 
it  is  the  food  of  fire  ;  how  could  fire  subsist  without  it  ?  It  could  not 
exist  long.  It  is  not  difiicult  to  conceive  that  the  interior  of  the  sea 
participates  equally  in  its  benefits.  The  animals  that  swim  there  could 
not  exist  without  respiration.  There  is  nothing,  in  fine,  that  does  not 
feel  its  efiects.-'= 

The  author  examines  next,  more  particularly,  the  influence  of  the 
breath  for  the  support  of  human  life.  He  observes  that  its  influence  is 
uninterrupted ;  that  man  may  abstain  more  easily  from  drinking  and 
eating  than  breathing,  from  which  he  concludes  that,  air,  being  the  thing 
most  indispensable  to  the  human  economy,  is  also  that  which  occasions 
in  it  the  gravest  and  most  frequent  disorders.  "  Thus  I  can  conceive 
that  the  principle  cause  of  disease  is  in  the  air.  This  may  be  too 
strong  or  too  feeble,  or  be  precipitated  in  the  body,  or  enter  it  charged 
with  miasms.  It  suffices  to  have  established  this  as  a  general  princi- 
ple ;  then,  by  descending  into  details,  I  will  explain  how  each  disease, 
in  particular,  proceeds  from  the  breath  or  air." 

Because  the  air  is  one  of  the  most  necessary  things  to  life,  and  if  you 
please,  the  most  necessary,  does  it  inevitably  follow  that  it  is  the 
unique  source,  or  at  least  the  most  common  source  of  diseases  ?  This 
does  not  appear  to  me  to  be  demonstrated.  But  I  do  not  insist  on  this 
general  objection  ;  it  is  particularly  in  the  face  of  facts  or  detailed 
observation,  that  our  systems  are  demolished.  Let  us  see  how  the 
pneumatic  system  stands  this  test ;  this  will  dispense  with  the  necessity 
of  longer  argument. 

The  fever  which  supervenes  after  an  improper  diet,  is  explained,  accord- 
ing to  this  system,  as  follows  :  "  Much  food  introduces  necessarily  much 
air ;  for  the  air  enters  more  or  less  into  the  body,  in  proportion  to  the 
quantity  swallowed  of  liquids  or  solids.  For  this  reason,  wind  is 
belched  up  after  eating  or  drinking  too  much.  The  air  being  thus 
compressed,  bursts  the  little  cells  in  which  it  is  contained,  and  mounts 
upward.  The  body  swells,  by  the  excess  of  air,  and  the  food  remains 
in  the  stomach,  prevented  by  the  great  quantity  of  air  from  passing 
into  the  intestines.  The  air  is  difi'used  into  all  parts  of  the  body,  and 
cools  even  the  most  sanguineous  portions  ;  it  goes  even  to  the  origin  and 
source  of  the  blood,  whence  it  is  spread  everywhere,  and  produces  the 
shivering  that  precedes  fevers.  The  more  air,  the  more  refrigeration, 
and  the  greater  the  shivering." 

I  will  limit  here  my  quotation  ;  the  reader  is,  I  think,  sufficiently 

^  Traite  des  Vents,  §  1.     Gardeil. 


138  PHILOSOPHIC  PERIOD. 

edified  on  the  value  of  this  pathological  system,  by  the  explanation 
which  is  offered  for  the  first  symptoms  of  fever.  Let  him  guard  him- 
self, nevertheless,  from  sentiments  of  pity  toward  the  ancients,  on 
account  of  the  theoretical  errors  he  discovers  in  their  writings ;  let 
him  remember  that  in  regard  to  theory,  even  the  most  eminent  moderns 
are  not  exempt  from  illusions,  which  will,  in  a  future  day,  excite  the 
smiles  of  those  who  shall  look  upon  them  in  another  and  superior  light 
to  ours.  The  deceptions  of  antique  science  should  render  us  circum- 
spect, and  cause  us  to  accept  with  reserve  the  assertions  of  cotempo- 
raneous  science. 


§  VI.  Theory  of  Any  Excedent. 

We  have  seen,  in  the  preceding  chapter,  synthesis  pushed  to  its  utmost 
limit,  and  all  the  phenomena  of  the  animal  economy  assimilated  to  each 
other,  and  united  by  the  bond  of  a  common  cause,  notwithstanding 
their  infinite  variety  and  enormous  differences.  But  in  order  to  arrive 
at  that,  to  perceive  in  the  formation  of  man,  in  the  development  of  his 
parts  and  the  exercise  of  his  faculties,  only  the  various  modifications  of 
one  single  agent,  such  as  air  or  fire,  it  was  necessary  to  clothe  this 
material  agent  with  imaginary  faculties  —  to  suppose  it  possessed  of 
instinct,  intelligence,  and  will,  which  no  observation  could  demonstrate  ; 
it  was  necessary,  in  short,  to  torture  the  facts,  and  create  an  ideal  world, 
such  as  is  seen  by  those  patients  to  whom  all  objects  appear  of  the  same 
color. 

These  Utopias  that  the  mind  invents,  by  means  of  abstractions,  in  the 
solitude  of  the  cabinet,  vanish,  ordinarily,  in  the  presence  of  the  real 
world,  or  phenomenal  truths.  To  dissipate  them,  it  is  only  necessary 
that  they  be  compared  with  daily  observations  —  to  test  them  by  the 
necessities  of  practice.  This  is  done  in  a  very  creditable  manner  by 
the  author  of  the  theory  which  we  now  proceed  to  examine.  The  work 
which  contains  it  is  entitled,  "  On  Ancient  Medicine,''  and  is  justly 
considered  one  of  the  most  creditable  of  the  collection.  Going  back 
to  the  infancy  of  the  Art,  it  developes  its  principles,  traces  its  progress 
with  much  sagacity,  and  indicates  the  best  method  to  follow,  to  insure 
its  progress  in  the  future  ;  it  lays,  in  short,  the  true  foundation  of 
medical  philosophy. 

The  critics  and  historians  are  nearly  unanimous  in  classing  this 
little  work  among  the  writings  posterior  to  Hippocrates.  M.  Littre, 
alone,  of  moderns,  charmed  by  the  excellent  doctrines  contained  in  this 
book,  is  not  willing  that  any  other  than  that  illustrious  man  shall  have 


SCHOOLS   OF  THE   ASCLEPIADiE.  139 

the  honor  of  its  authorship."  The  principal  document  on  which  he 
bases  an  opinion  contrary  to  the  common  sentiment,  is  a  passage  from 
Plato,  in  which  that  philosopher,  without  designating  precisely  the 
book  of  Ancient  Medicine,  seems  to  make  allusion  to  it.  I  avow,  that 
after  having  read  the  passage,  and  the  learned  commentary  with  which 
M.  Littre,  accompanies  it,  I  am  still  with  the  common  opinion.  1 
have  preserved,  also,  in  the  passages  which  I  quote  from  the  book,  the 
translation  of  Gardeil,  because  it  is  on  that  translation  that  I  made  my 
first  study,  and  consequently  it  is  better  adapted  to  my  arguments ; 
besides,  it  does  not  differ  materially  from  that  of  M.  Littre  ;  for  it  is  seen 
by  comparing  them,  that  these  interpretations  express  the  same  ideas  in 
diflferent  forms.f 

The  author  opens  with  an  argument,  in  which  he  shows  that  Medicine 
has  not  been  founded  on  uncertain  or  obscure  hypothetic  opinions,  but 
on  the  manifest  observation  of  the  good  or  evil  results  which  follow  a 
certain  regimen  and  treatment,  or  action.  He  asserts,  that  the  best 
method  for  making  any  improvement  on  the  discoveries  of  past  times  is,, 
not  to  jump  foolishly  into  eccentric  and  unknown  ways,  but  follow  with 
perseverance  the  beaten  route  of  experience,  which  alone  will  conduce  to 
real  progress. 

Like  all  the  hypotheses  emitted  at  that  epoch,  to  explain  the  phenom- 
ena of  the  animal  economy,  that  of  the  four  elementary  qualities  had  for 

"-'  He  expresses  himself  about  it  as  follows:  "  The  book,  Ancient  Medicine,  so 
remarkable  for  the  correctness  of  judgment,  and  depth  of  thought,  is  no  less  so 
in  the  beauty  and  excellence  of  its  style.  The  arrangement  is  worthy  of  its 
matter.  The  periods,  generally  long,  are  constructed  with  perfect  regularity; 
the  members  of  the  phrases  are  balanced  and  finished  in  a  way  to  please  the  ear, 
as  well  as  the  mind ;  the  style,  clear,  and  full  of  truthfulness,  is  always  grave  and 
firm,  yet,  nevertheless,  it  is  enriched,  (se  colore)  from  interval  to  interval,  in  a 
way  that  shows  a  writer,  who,  master  of  his  subject  and  of  himself,  is  restrained 
within  the  limits  of  a  natural  taste.  It  is  certainly  a  fine  specimen  of  Greek 
literature,  and  a  finished  model  of  scientific  discussion,  on  the  general  and  most 
important  points  in  Medicine."  (CEuvres  d'Hippocrate,  De  I'Ancienne  Medicine, 
page  56o.) 

t  I  can  only  summarily  indicate  the  reasons  which  make  me  take  the  common 
view.  1st.  The  book  of  Ancient  Medicine  refutes  the  system  of  four  elements, 
which  was  that  of  Plato ;  it  proclaims  the  superiority  of  the  experimental 
method,  and  Plato,  as  we  shall  see  hereafter,  is  the  Corypheus  of  an  entirely 
opposite  method.  How  then  could  this  philosopher  have  proposed,  as  a  model,  a 
doctrine  contrary  in  all  points  to  his  own  ?  2d.  The  passage  in  Plato,  considered 
in  itself,  seems  to  relate,  according  to  Galen,  as  well  to  the  book,  on  the  Nature 
of  Man,  as  it  does,  according  to  M.  Littre',  to  the  work  on  Ancient  Medicine. 
(See  the  introduction  to  the  CEvures  d'Hippocrate,  by  M.  Littre',  t.  1,  p.  294,  et 
3uiv.,  and  to  the  first  paragraphs  of  the  book  on  la  Nature  de  I'Homme.) 


140  PHILOSOPHIC   PERIOD. 

its  support  the  most  respectable  authorities,  such  as  Hippocrates,  Plato, 
Aristotle,  and  the  majority  of  physicians ;  but  our  philosopher  boldly 
attacks  that  hypothesis,  and  refutes  it  in  an  entirely  special  manner. 

"All  those,"  he  says  in  the  commencement,  "  who  have  undertaken 
to  speak  or  write  on  Medicine,  and  who  have  established  their  doctrines 
on  the  hypotheses  of  cold  or  heat,  of  dryness  or  moisture,  reducing  thus 
to  one  or  two  principles  the  causes  of  the  death  and  diseases  of  men,  are 
manifestly  mistaken  in  the  greater  part  of  the  things  that  they  have 
advanced.  I  think,  therefore,  in  this  art  it  is  not  proper  to  have 
recourse  to  vain  conjectures,  as  is  necessary  in  treating  of  things  entirely 
above  our  appreciation,  and  which  are  of  no  benefit  to  those  who  under- 
take to  discuss  or  write  about  them."" 

After  pointing  out,  rapidly,  what  it  is  necessary  to  avoid  in  the  study 
of  Medicine,  the  author  indicates,  immediately,  what  it  is  proper  to  do, 
and  his  entire  method  may  be  summed  up  by  the  following  aphorism : 
Observe  attentively  what  is  useful  or  injurious  to  health ;  examine  in 
what  each  thing  is  good  or  bad  ;  but  put  no  subtlety  in  this  research ; 
hold  simply  and  purely  to  the  testimony  of  the  senses. 

This  method  was  not  entirely  new ;  Hippocrates  had  alluded  to  it, 
somewhat,  in  his  work  on  the  "  Nature  of  Man,"  but  it  was  not  expressed 
in  terms  as  formal  and  explicit  as  are  found  in  the  work  on  Ancient 
Medicine.  The  author  of  this  labors  constantly  to  join  example  to  pre- 
cept ;  he  appropriates  to  himself,  in  some  degree,  this  method,  by  the 
developement  he  has  given  it,  and  the  proofs  by  which  he  sustains  it. 

"  It  seems  to  me,  primarily,"  he  says,  "  that  in  treating  of  the  heal- 
ing art.  we  must  advance  views,  the  accuracy  of  which  every  one  can 
appreciate,  because  the  discourses  and  researches  of  physicians  should 
aim  only  at  the  diseases  to  which  every  one  is  subject.  It  is,  therefore, 
necessarily  the  observation  of  the  manifestation  of  good  or  evil  results 
which  has  led  to  the  search  for  and  discovery  of  this  Art.  Indeed,  it 
has  been  discovered,  by  observing,  that  the  sick  were  made  worse  by  the 
use  of  the  same  food  that  healthy  men  employ,  which  is  still  verified 
every  day. 

"  What  difi'erence  can  be  put  between  the  invention  of  a  man  who  has 
marked  out  the  regimen  suitable  to  the  sick,  who  practices  what  every 
one  calls  Medicine,  and  who  is  recognized,  generally,  as  a  physician, 
and  the  invention  of  him,  who,  in  the  earliest  times,  changed  the 
ancient,  wild,  crude  food,  for  those  various  preparations  of  aliment  now 
in  use.  Tor  myself,  I  think  it  is  the  result  of  the  same  method — a 
similar  discovery.     The  first  led  to  the  suppression  of  food,  too  gross  to 

'*De  I'Ancienne  Medicine.  §  1,  3.  Gardeil. 


SCHOOLS   OF   THE    ASCLEPIADiE.  141 

be  assimilated,  even  in  a  state  of  health ;  the  second,  has  interdicted 
aliment  too  indigestible  in  certain  cases,  considering  the  particular 
circumstances.  There  is  no  other  diflference.  according  to  my  view, 
except  that  the  field  of  the  latter,  being  more  varied  and  extensive, 
requires,  consequently,  more  discrimination  aud  experience ;  but  the 
first  invention  is  nevertheless  the  mother  of  the  second."'-' 

In  this  way  the  ajithor  refers  the  creation  of  Medicine  to  the  first 
essays  made  by  man  to  ameliorate  the  conditions  of  his  existence.  He 
demonstrates  that  the  same  instinct,  which  led  him,  so  early,  to  make  a 
choice  among  the  articles  of  food  at  his  disposal,  prepare  them  by  cook- 
ing, and  in  various  other  ways,  for  the  purpose  of  gratifying  his  taste 
and  rendering  digestion  more  easy ;  the  same  instinct,  I  repeat,  also 
suggested  to  him  to  seek  means  to  alleviate  pain  ;  and  that  experience 
taught  him,  gradually,  not  to  follow  the  same  regimen  in  disease  as  in 
health,  and  to  employ  for  his  restoration  to  health,  a  variety  of  means. 

The  first  rules  of  hygiene  and  therapeutics,  not  being  the  fruit  of 
any  hypothesis,  but  of  experiment,  he  concludes  that  we  may  not  hope 
for  perfection  in  these  sciences,  except  by  the  experimental  method. 
"Every  man,"  he  cries  out,  "who  rejects  approved  rules,  and  takes  a 
new  path,  and  boasts  of  having  added  something  to  the  art,  deceives 
himself,  as  well  as  others."  He  proscribes  all  the  transcendental  specu- 
lations in  which  men  were  in  the  habit  of  indulging,  in  his  times,  on  the 
nature  of  man,  and  the  essence  of  diseases.  He  regards  them  as  a  mere 
amusement — a  play  of  the  imagination. 

"There  are,"  says  he  "  certain  sophists,  among  whom  may  be  counted 
even  some  physicians,  who  j)retend,  that  to  comprehend  Medicine  well, 
it  is  necessary,  in  the  first  place,  to  understand  what  man  is  in  his 
nature,  how  he  was  first  made,  and  from  what  he  was  formed.  For 
myself,  I  think  that  all  which  the  sophists  wrote  on  the  human  nature,  is 
less  useful  to  physicians  than  to  the  makers  of  books,  and  that  we  can 
not  hope  to  arrive  at  any  certainty  touching  the  constitution  of  man, 
unless  we  obtain  it  by  medical  observations.  All  that  is  necessary  for 
any  practitioner,  who  wishes  to  succeed  in  his  art,  to  understand  concern- 
ing nature,  is  the  relation  of  man  to  his  food  and  drink,  and  the  changes 
which  different  kinds  of  these  may  effect  in  him." 

We  see  with  what  sagacity  our  philosopher  connects  the  question  in 
physiology  with  the  experimental  method.  He  does  the  same  for  the 
problems  of  pathology  and  therapeutics.  If  it  is  required,  for  example, 
to  explain  the  generation  of  diseases,  he  does  not  have  recourse  to  occult 
causes,  such  as  elementary  fire,  or  radical  moisture,  but  to  causes  apparent 

*  Traite  de  rAncienne  Medicine,  §  5. 


142  PHILOSOPHIC   PERIOD. 

and  appreciable  by  everybody,  such  as  excess  of  eating  and  drinking, 
the  fault  in  prepai-ation,  or  the  bad  quality  of  articles  of  food.  He 
does  not  deny  that  the  excess  of  heat  or  cold,  of  dryness  or  humidity, 
may  become,  in  certain  eases,  the  causes  of  diseases ;  but  he  insists  that 
these  primitive  elements  do  not  possess  the  character  of  morbid  agents 
in  all  affections,  nor  even  in  the  greater  number,  and  he  proves  it  from 
examples  drawn  from  daily  observation.  % 

"  Let  us  take,"  he  says,  "  a  man  of  feeble  temperament.  Suppose  he  eats 
grain  from  the  garner,  with  raw  flesh,  and  drinks  jiure  water ;  this  will 
cause  him  much  pain,  his  stomach  will  become  deranged,  his  body  waste 
away,  and  he  will  not  live  long.  What  must  be  given  to  him  ?  Heat, 
cold,  dryness,  or  moisture  ?  If  it  is  pretended  that  either  of  these  ele- 
ments has  caused  the  disease,  the  cure  is  to  be  effected  by  employing  its 
opposite.  The  surest  and  promptest  remedy  will  always  be  found  to  be  a 
change  of  food :  to  give  bread  instead  of  grain,  cooked  meat  instead  of 
raw  flesh,  and  to  add  wine  to  his  drink. "=••■= 

The  substances  on  which  man  sustains  himself  are  endowed  with 
secondary  qualities,  such  as  bitter,  saline,  sweet,  acid,  and  many  others, 
the  effects  of  which  are  more  sensible,  and  more  persistent  than  the 
effects  of  the  primary  qualities  ;  from  which,  our  author  concludes  that  the 
first  more  frequentl}^  give  rise  to  diseases  than  the  last.  He  represents 
the  action  of  the  secondary  principles,  on  the  animal  economy,  as  follows : 
"  There  are  in  man,  bitter,  salt,  sweet,  acid,  and  a  hundred  other  similar 
humors  of  different  powers,  according  to  their  quantity  and  degree  of 
energy.  All  these  things,  when  well  mixed  and  tempered  by  each  other, 
are  harmless  and  unfelt ;  but  when  one  of  them  is  separated,  and  ia 
alone,  it  is  felt,  and  makes  great  havoc  in  the  body.  It  is  the  same 
with  articles  of  food ;  those  which  are  not  fit  for  use,  are  either  bitter, 
salt,  acid,  or  too  strong;  on  this  account  they  cause  the  same  inconveniences 
as  the  humors  of  which  I  have  spoken ;  but  those  which  are  suitable 
for  us,  have  none  of  these  violent  or  excessively  strong  qualities." 

In  the  other  theories,  no  account  is  made  of  secondary  qualities, 
because  they  are  regarded  as  simple  compounds,  but  nothing  proves  that 
they  are  so.  No  observation  or  analysis  has  shown  how  the  bitter,  salt, 
sweet,  and  acid  resulted  from  the  combination  of  heat,  cold,  dryness,  or 
moisture.  It  was,  then,  just  as  rational  to  study  the  effects  of  secondary 
qualities  as  those  that  were  pretended  to  be  primary.  It  was  rational 
to  observe  how  each  of  these  principles  acted,  either  when  manifested 
spontaneously  in  the  natural  humors  of  the  body,  or  when  introduced 
into  the  economy  by  alimentary  substances. 

'■*  De  I'Ancienne  Medicine.  §  XL 


I 


SCHOOLS   OF   THE   ASCLEPIADiE.  143 

The  following  extract  shows  the  general  course  of  action  of  these 
violent  humors,  according  to  this  system:  "  We  have,"  says  the  same 
writer,  "  as  above  shown,  one  example,  among  others,  which  seems  to  me 
to  be  clear  and  conclusive.  When  we  have  a  stoppage  in  the  nose,  from 
a  cold,  and  a  cory'za  supervenes,  is  it  not  true  that  this  humor  becomes 
more  piquant  and  caustic,  in  proportion  to  the  abundance  of  the  dis- 
charge ;  that  it  causes  the  nose  to  swell,  which  becomes  inflamed  and 
heated  to  such  an  extent  that  the  heat  may  be  felt  when  the  hand  is 
carried  to  it  ?  If  the  same  fluxion  continue  long,  the  humor  makes  exco- 
riations on  this  hard  and  fleshless  part.  This  ardor  is  at  length  dissi- 
pated ;  but  how  ?  Not  while  the  humor  flows,  and  there  is  inflammation, 
but  when  the  humor  becomes  thicker,  less  sharp,  more  concocted,  and 
perfectly  tempered." 

"It  is  the  same  for  all  the  other  derangements  that  I  suppose  to  pro- 
ceed from  the  acridity  and  severe  nature  of  the  humors  ;  they  cease 
only  when  the  humors  are  all  matured  and  tempered.  How  many  times 
do  we  see  fluxions  from  the  eyes,  caused  by  every  sort  of  acridity,  which 
ulcerates  the  lids,  excoriates  the  cheeks,  breaking  up  and  destroying 
even  the  thick  membrane  that  envelopes  the  pujjil  of  the  eye  !  When 
and  how  do  pains  and  inflammations  here  cease  ?  It  is  only  after  the 
humors  have  been  matured,  become  denser,  and  have  been  changed  into 
purulent  matter.  Now  this  coction  is  eff'ected  by  the  proper  tempering 
of  the  humors." 

The  author  cites  still  other  examples,  and  concludes  in  these  terms : 
"  Must  we  not  take,  for  the  cause  of  a  disease,  that  which,  when  appear- 
ing in  one  form,  is  invariably  followed  by  this  disease,  then,  changing, 
brings  about  a  corresponding  change  in  the  state  of  the  disease,  and,  at 
last,  by  disappearing,  leaves  the  patient  without  any  affection." 

The  rule  here  laid  down  to  discern  the  causes  of  diseases,  is  not  as 
well  founded  nor  as  infallible  as  the  author  thinks ;  in  following  it  with- 
out discernment,  we  would  be  liable  frequently  to  take  for  the  cause  of 
a  disease,  that  which  is  only  an  essential  symptom  or  constant  eff'ect. 
Thus,  in  the  examples  reported  above,  the  acrid  humors  which  flow  from 
the  nose  in  coryza,  and  from  the  eyes  attacked  with  ophthalmia,  are  no- 
thing more  than  symptoms  or  effects,  that  accompany  these  affections 
nearly  as  constantly  as  the  shadow  does  the  body.  The  author  is  then 
mistaken  in  supposing  these  humors  to  be  the  causes  of  the  concomitant 
diseases,  and  the  pathogenetic  rule  that  he  has  laid  down  admits  of  many 
exceptions.  Nevertheless,  his  theory  is  less  erroneous  than  any  of  the 
preceding  that  I  have  cited,  because  it  never,  or  very  rarely  ever,  for- 
sakfes  observation ;  while  the  others,  disregarding  observation,  lose  them- 
selves almost  immediately  in  the  shadowy  field  of  fictions.     If  it  is 


144  PHILOSOPHIC   PERIOD. 

untrue,  to  say  that  the  humors  which  flow  from  the  eyes  and  nose  when 
these  organs  are  diseased,  are  the  primary  causes  of  the  disease,  it  is 
nevertheless  certain  that  these  humors  give  rise,  at  least,  to  some  second- 
ary accidents,  such  as  ulceration  of  the  lids,  and  margin  of  the  nose,  etc. 
They  are  thus  at  once  cause  and  eiFect,  as  are  all  organic  phenomena. 

Neither  has  the  author  of  the  Treatise  on  Ancient  Medicine  totally 
overlooked  the  solid  parts  of  the  body  ;  he  says  something  of  them  in  the 
last  paragraphs,  and  insists  on  the  necessity  of  studying  their  structure 
and  configuration.  If  the  reader  finds  the  reflections  of  our  physiologist, 
on  this  subject,  deficient  in  development  and  depth,  I  shall  not  deny  it ; 
but  I  will  say,  that  it  is  also  necessary  to  bear  in  mind  the  little  ad- 
vancement of  the  lights  of  his  age  on  this  branch  of  physiology.  It  must 
be  recollected  that  at  that  epoch  descriptive  anatomy  was  in  its  infancy, 
and  that  pathological  anatomy  did  not  yet  exist,  from  the  impossibility- 
of  making  regular  dissections.  This  writer  has  done  all  which  was  pos- 
sible to  do  in  this  respect.  By  insisting  on  the  necessity  of  acquiring 
positive  notions  concerning  the  form  and  structure  of  organs,  he  has 
traced  the  route  that  should  be  followed,  and  which  since  has  success- 
fully been  done. 

Moreover,  he  did  not  overlook  the  influence  of  the  vital  force  or  the 
organic  reaction  on  the  development,  progress,  and  termination  of  dis- 
eases. He  speaks  of  it  more  or  less  explicitly  in  several  places ;  notably, 
when  he  recommends  particular  attention  to  be  paid  to  the  crises  and 
critical  days. 

Thus,  then,  as  I  announced  at  the  commencement  of  this  chapter,  we 
find  in  the  book  on  Ancient  Medicine,  precious  researches  on  the  origin 
and  progress  of  the  Art ;  a  reasonable  development  of  the  experimental 
method  already  advised  by  Hippocrates  ;  the  largest  jjathogenetic  system 
which  had  yet  appeared — a  system,  in  short,  which  may  be  summed  up 
as  follows :  the  causes  of  diseases  must  be  sought  in  every  agent  that 
afiects  our  constitution  beyond  certain  limits,  whether  coming  from  with- 
out or  residing  within  us. 


§  VII.     Resume  of  the  Hippoceatic  Theories. 

The  first  of  these  theories,  that  of  coction  and  crisis,  is  founded  on 
the  capital  observation  that  there  exists  in  the  organized  body  an  in- 
trinsic force,  diff"used  in  all  its  parts,  creating  a  mutual  sympathy,  and 
harmonizing  their  various  functions  for  a  common  end,  by  a  kind  of 
instinct.  One  of  the  most  distinct  characters  of  this  force  is  its  inter- 
mittence  in  regard  to  some  of  these  functions,  which  is  never  seen  in 
brute  forces.     These  intermissions,  which  are  seen  in  certain  diseases, 


SCHOOLS   OF  THE   ASCLEPIAD^.  145 

produce  in  them  periods,  more  or  less  regular,  named  critical  periods 
or  ci'ises.  But  there  are  also  many  diseases  in  which  these  periods  do 
not  occur,  or  are  not  appreciable ;  and  the  fault  of  the  ancient  Hippo- 
cratists  consisted  in  extending  the  theory  of  crisis  to  all  pathology. 

Force,  or  vital  forces,  would  appear  to  be  inherent  to  the  organs, 
being  dependent  entirely  or  in  part  on  the  constitution  of  these ;  it  was 
then  essential  to  study  that  constitution  ;  but  the  Asclepiadce  were  pre- 
vented from  proceeding  to  that  study,  by  cotemporaneous  prejudices. 

On  the  other  hand,  the  vital  or  organic  forces  act  upon  the  substances, 
liquid,  solid,  or  gaseous,  whether  existing  in  the  body  or  coming  from 
without.  These  substances,  endowed  with  properties  more  or  less  ener- 
getic, modify  the  functions  of  the  organs,  which  made  it  necessary  for 
the  physician  to  be  acquainted  with  their  properties.  Now,  as  physics 
and  chemistry,  which  alone  can  furnish  this  knowledge,  were  too  incom- 
plete to  afford  the  ancient  physiologists  but  vague  or  false  notions,  the 
medical  theories  varied  much  in  this  respect. 

The  greater  part  of  the  naturalists  of  antiquity,  recognised  four  pri- 
mary forms  of  matter,  and  pretended  to  derive  from  them  all  the  physi- 
cal properties  of  the  body.  In  like  manner,  the  majority  of  the  phy- 
sicians supposed  four  cardinal  humors,  on  which  depended  all  the  phy- 
siological and  pathological  phenomena. 

Again,  a  small  number  of  naturalists  recognised  but  two,  or  even 
one  element ;  and  also,  following  their  example,  a  few  physicians  would 
only  admit  two  physiological  elements,  and  again,  others  only  one. 

In  the  midst  of  this  conflict,  a  few  men,  more  attentive,  and  less  pre- 
judiced, made  the  observation,  that  there  is  no  proof  that  all  material 
substances  proceed  from  one  or  two,  or  four  elements  only,  and  that  no 
one  has  ever  seen  the  combination  of  a  given  dose  of  heat,  cold,  dryness, 
and  humidity,  engender  either  bitter,  acid,  sweet,  or  any  other  pretended 
secondary  quality.  They  concluded  that  this  division  of  the  physical 
properties  of  bodies  into  primitive  and  secondary,  was  false,  or  at  least  hy- 
pothetical, and  were  desirous  that  only  dogmas,  which  are  experimentally 
demonstrated,  should  be  admitted  into  the  science.  This  was  calculated 
to  provoke  a  theoretic  reform,  for  which  the  age  was  not  yet  prepared. 
We  shall  see  its  advent  in  the  next  period. 

The  Medical  School  of  Cos,  after  Hippocrates. 

The  eclat  that  Hippocrates  had  given  to  the  teaching  of  the  Ascle- 
piadse  of  Cos,  survived  him :  many  members  of  his  family  followed  in 
his  footsteps,  and  sustained  the  honor  of  his  school.  Among  others, 
may  be  mentioned  Thessalins  and  Draco,  his  sons,  and  Polybius,  his 


146  PHILOSOPHIC   PERIOD. 

son-in-law,  to  whom  are  attributed  some  of  the  writings  that  form  a 
part  of  the  Hippocratic  collection. 

Not  long  after  them,  Diocles  of  Carystus  flourished  in  the  same 
schools,  who  was  surnamed  by  the  Athenians,  the  second  Hippocrates, 
and  Praxagoras,  of  Cos,  the  last  of  the  Asclepiadae,  of  whom  mention 
is  made  in  the  history  of  medicine.  Both  composed  several  works  that 
are  entirely  lost.  Praxagoras,  who  is  supposed  to  have  belonged  to  the 
family  of  Hippocrates,  was  distinguished  principally  for  his  anatomical 
knowledge.  He  supposed,  like  Aristotle,  that  the  veins  originated  at  the 
heart.  He  did  not  confound  these  vessels  with  the  arteries,  as  many  of 
his  predecessors,  and  Hippocrates  himself,  had  done.  He  supposed  they 
only  contained  air,  or  the  vital  spirit.  It  is  thought  that  he  dissected 
the  human  body. 

Praxagoras  was  the  first  to  remark  the  close  connection  between  the 
changes  in  the  pulse,  and  the  dynamic  state  of  the  economy.  He  was 
also  the  first  who  attempted  to  give  an  explanation  of  that  singular 
phenomenon,  and  thus  laid  the  foundation  of  sphygmology,  for  before 
him,  medical  men  had  not  given  this  much  attention.  The  Hippocratic 
works  rarely  allude  to  the  arterial  pulsations,  among  the  symptoms  of 
diseases,  and  when  spoken  of,  only  a  secondary  importance  is  attached 
to  them.  But,  ultimately,  the  observations  of  Praxagoras  became  a 
fruitful  source  of  indications ;  this  order  of  signs  was  even  greatly 
exaggerated,  as  always  happens  in  great  discoveries,  and  efi'orts  were 
made  to  build  on  this  unique  foundation,  an  entirely  new  system  of 
semeiology. 

The  reigning  theory  in  the  school  at  Cos,  as  we  have  before  said,  was 
that  which  made  the  health  depend  on  the  exact  proportion  of  the  ele- 
ments of  the  body,  and  on  the  perfect  combination  of  the  cardinal 
humors — the  blood,  bile,  phlegm,  and  atrabile.  Thistheory  was  generally 
attributed  to  Hippocrates.  According  to  it,  all  diseases  proceed  from 
one  of  the  four  elements,  heat,  cold,  dryness,  or  moist,  the  excess  of 
which  engendered  some  humor  badly  concocted,  or  too  abundant,  which, 
by  extravasation  from  its  natural  reservoirs,  passes  into  parts  not 
habituated  to  its  presence.  The  equilibrium  is  established  by  the  coction 
and  evacuation  of  the  piccant  humor.  This  doctrine,  which  was  taught 
almost  exclusively,  until  the  foundation  of  the  school  at  Alexandria, 
constituted  the  ancient  Dogmatism,  so  named,  doubtless,  because  it  em- 
braces the  most  anciently  professed  dogmas  in  medicine. 

Amongst  the  most  famous  sectators  of  the  Hippocratic  Dogmatism, 
we  shall  name  two  philosophers,  Plato  and  Aristotle,  whose  opinions 
have  exercised  a  great  influence  on  the  march  of  the  human  mind  in 
general,  and  particularly  in  respect  to  medicine. 


SCHOOLS   OF  THE   ASCLEPIADJ5.  147 


ART.  I.    PLATO. 


The  first  of  these  philosophers  was  endowed  with  a  lively  and  bril- 
liant imagination,  and  clothed  with  the  charms  of  a  seducing  language, 
the  purest  morals  in  paganism.  In  lending  to  the  grave  teachings  of 
Socrates,  the  graces  and  liveliness  of  his  spirit,  Plato  secured  for  them 
immense  popularity,  and  an  eternal  duration,  which  they  would  not, 
perhaps,  have  obtained  without  these  foreign  ornaments.  But  we  have 
not  to  consider  here,  either  the  profound  moralist  or  elegant  writer, 
worthy  of  the  surname  of  the  Swan  of  the  Academy ;  we  can  only 
occupy  ourselves  with  Plato  in  his  character  of  physician,  and  especially 
in  that  of  physiologist. 

Let  us  see,  in  the  first  place,  what  mode  of  acquisition  he  employed 
in  the  study  of  the  physical  sciences.  We  shall  let  him  speak  for  him- 
self. "  Very  well,"  he  says,  in  the  Phsedon,  "  is  anything  more  rational 
than  to  think  by  the  thoughts  alone,  disengaged  from  all  foreign  or  sen- 
sible agency  ;  to  apply  at  once  the  pure  essence  of  thought  in  itself,  to  the 
research  of  the  pure  essence  of  each  thing  in  itself,  without  the  ministry 
of  the  eyes  and  ears,  without,  in  short,  any  intervention  of  the  body, 
whose  slightest  influence  only  troubles  the  soul,  and  prevents  it  finding 
wisdom  and  truth.  If  we  arc  ever  to  attain  the  knowledge  of  the 
essence  of  things,  must  it  not  be  in  this  manner?" '■■■= 

It  is  clear,  from  what  we  have  just  quoted,  that  Plato  undertook  the 
study  of  the  physical  diseases,  not  by  method  of  observation  and  exper- 
iment, but  by  that  of  pure  meditation — by  mental  intuition.  The 
following  passage  proves  that  he  applied  that  method,  not  only  to  meta- 
physics and  morals,  but  also  to  physics  and  physiology:  "During  my 
youth,"  he  continues,  '•  1  had  an  intense  desire  to  learn  that  science 
which  is  termed  physics.  I  felt  that  it  would  be  sublime  to  know  the 
cause  of  each  thing  ;  what  created,  destroyed,  and  sustained  it  in  exist- 
ence. I  was  tormented,  in  a  thousand  ways,  by  my  efibrts  to  learn 
whether  it  is  the  cold  and  hot  elements  in  a  state  of  corruption,  as  some 
pretend,  which  form  animated  beings;  if  it  is  the  blood,  or  air,  or 
fire  that  causes  us  to  thiak,  or  whether  it  is  either  of  these,  or  the  brain 
alone,  that  produces  in  us  all  our  sensations,  sight,  hearing,  and  smell, 
which,  in  their  turn,  produce  memory  and  imagination  ;  which,  by  reflec- 
tion create  science.  I  reflected,  also,  on  the  decomposition  of  all  these 
things,  of  the  changes  which  take  place  in  the  heavens  and  the  earth, 
and  at  last  would  find  myself  confused  and  wholly  disqualified  for  such 
researches."! 

^  (Euvres  completes  de  Platon,  translated  by  M.  Cousin,  page  203. 
t  Ibid.,  p.  273. 


148  PHILOSOPHIC   PERIOD. 

The  meditations  of  our  philosopher  having  resulted  in  no  positive 
knowledge  touching  the  questions  that  he  was  anxious  to  understand, 
he  did  not  deduce  therefrom  the  very  natural  consequence,  that  it  was 
possible  that  he  might  have  followed  a  false  course,  and  that  the  method 
which  conducts  most  certainly  to  the  discovery  of  abstract  truths,  such 
as  the  axioms  of  metaphysics,  and  morals,  was  not  as  sure  to  attain  the 
knowledge  of  material  things,  of  the  truth  of  observation.  •'•'  Plato 
never  suspected  the  excellence  of  his  method,  and  he  was  never  tempted 
to  try  any  other ;  thus  despairing,  he  returns  to  the  origin  of  things,  to 
explain  in  what  their  essence  consists,  when,  having  heard  read  in  a 
book  of  Anaxagoras,  the  following  proposition :  mind  is  the  regulator 
and  'principle  of  all  tilings — "  this  idea,"  he  says,  "  struck  me  like  a 
stream  of  light." 

Nothing  more  was  necessary  to  inflame  the  imagination  of  the  phi- 
losopher of  the  Academy,  and  create  in  his  brain  an  entirely  new  system 
of  physics.  See  how  he  reasons :  "  Since  the  intelligence  is  the  first 
cause  of  all  things,  it  must  have  ordered  all  things  for  the  best  possible 
end ;  then,  if  any  one  desires  to  find  the  cause  of  everything,  how  it 
originates,  perishes,  or  exists,  he  has  only  to  ascertain  to  what  end  such 
thing  is  destined.  Therefore,"  he  adds,  "I  comprehend  no  longer, 
all  the  other  learned  causes  that  are  offered  us,  but  if  any  one 
comes  to  tell  me  what  it  is  that  makes  a  thing  beautiful,  or  gives  it 
liveliness  of  colors,  or  forms,  or  other  similar  things,  I  leave  aside  all 
these  reasons,  which  only  perplex  me,  and  I  assume,  myself,  without  plan 
or  art,  and  probably  too  simply,  that  nothing  gives  beauty  but  the 
presence  or  communication  of  the  original  beauty,  in  whatever  way  this 
coummunication  may  take  place  on  this  subject.  I  afiirm  nothing,  ex- 
cept that  all  things  beautiful  are  beautiful  by  the  presence  of  beauty. ''■\. 

The  reason  which  Plato  has  given  for  the  beauty  of  things,  naturally 
recalls  that  famous  response  of  the  schools  of  the  Middle  Ages,  to  the 
question.  Why  does  opium  produce  sleep?  Because  it  possesses  the  sleepy 
principle.  But  the  passage  we  have  just  quoted,  merits  the  attention  of 
the  reader  for  more  serious  reasons ;  for  it  shows  how  and  why  the  con- 
sideration of  final  causes  was  introduced  into  the  natural  sciences ;  a 
consideration  that  has  played  an  important  part  in  more  than  one  sys- 
tem of  physics  and  physiology — one  of  the  most  unfortunate  results  of 

*  This  is  not  the  place  to  examine  if  the  same  mode  of  acquisition  is  applicable 
to  all  branches  of  human  knowledge,  as  many  ancient  and  modern  philosophers 
have  thought.  This  important  question  will  become  more  proper  in  another 
chapter,  where  we  shall  treat  it  with  all  the  consideration  it  merits. 

fCEuvres  Completes  de  Platon,  page  283. 


SCHOOLS   OF  THE   ASCLEPIAD^.  149 

which  has  been  to  divert  the  human  mind  from  the  path  of  observation 
and  experiment,  and  lull  it  into  a  species  of  quietism,  extremely  con- 
trary to  the  progress  of  light. 

But  without  anticipating  the  results  that  the  Platonic  method  was 
destined  to  produce — results  which  we  shall  hereafter  see  develope  them- 
selves— let  us  be  content,  for  the  moment,  with  examining  the  benefit 
that  Plato  himself  realised  from  it,  in  regard  to  the  explanation  of  natu- 
ral phenomena.  As  all  parts  of  his  philosophy  are  intimately  connected, 
as  is  the  case  in  that  of  Pythagoras,  I  shall  be  compelled  to  say  some- 
thing of  his  cosmogony  before  exposing  his  physio-pathologic  ideas :  and 
if  I  am  not  always  able  to  shed  upon  these  abstract  matters  the  clear- 
ness I  would  desire,  I  pray  the  reader  to  remember  that  the  subtle 
Aristotle  himself,  the  assiduous  auditor  of  Plato,  sometimes  found  the 
conceptions  of  his  master  too  difiicult  to  follow.  It  is  in  the  dialogue 
entitled  Timseus,  that  the  founder  of  the  Academic  sect  has  deposited  the 
products  of  his  meditations  touching  the  nature  of  created  beings  in 
general,  and  of  man  in  particular ;  and  it  is  from  it  that  we  extract  the 
following  summary. 

Plato,  like  Pythagoras,  maintained  the  idea,  that  God  and  matter 
existed  from  all  eternity ;  but  that  matter  in  itself  had  no  form,  prop- 
erty, or  force.  God  gave  it,  from  the  beginning,  a  triangular  form  ; 
afterward,  taking  a  certain  number  of  primitive  triangles,  he  composed 
the  four  primary  elements,  which  we,  in  this  lower  world,  term  fire,  air, 
earth,  and  water.  Fire,  which  is  the  most  subtle,  is  made  up  of  the 
smallest  number  of  triangles ;  it  has  the  figure  of  a  pyramid.  The  air 
represents  a  solid  of  twelve  faces,  a  dodecahedron.  Water  has  the  form 
of  an  icosahedron,  or  a  solid  of  twenty  faces.  Finally,  the  earth,  the 
heaviest  of  all  the  elements,  constitutes  a  hexahedron,  that  is  to  say,  a 
perfect  cube,  composed  of  right-angled  triangles. 

Thus,  Plato,  having  borrowed  from  the  philosopher  of  Samos  the 
dogma  of  the  homogenity  of  matter,  went  yet  farther  than  he  in  the  field 
of  hypothesis,  for  he  attempts  even  to  determine  the  primitive  figure 
that  the  Creator  must  have  given  to  atmospheric  matter.  He  pretends 
that  this  figure  is  a  triangle,  because,  of  all  the  surfaces,  the  triangular 
is  the  most  simple,  and  there  is  no  geometrical  figure  which  may  not  be 
divided  into  triangles. 

AVhile  matter  remains  in  its  elementary  state,  it  does  not  affect  our 
senses  in  any  way.  For  matter  to  become  perceptible,  it  is  necessary 
that  several  elements  unite,  and  form  an  aggregate.  Thus  all  the  mate- 
rial substances  which  we  know,  and  to  which  we  assign  particular  names, 
result  from  the  assemblage  of  various  elements.  Water,  for  example, 
which  we  see,  feel,  and  employ  in  so  many  various  ways,  is  not  elementary 


150  PHILOSOPHIC   PERIOD. 

water.  The  liquid  body  which  we  call  water  is,  according  to  Plato, 
a  compound,  in  which  the  aqueous  element  enters  in  a  much  larger 
proportion  than  the  other  elements. 

This  philosopher  also  admits,  with  Pythagoras,  the  existence  of  diflfer- 
ent  orders  of  created  spirits.  He  says,  that  the  Supreme  Intelligence 
charged  the  secondary  gods  with  the  formation  of  mortal  animals. 
These  gods,  having  received  from  the  hands  of  the  Celestial  Father  the 
immaterial  principle  of  the  human  soul,  fashioned  a  body  for  it  with 
the  most  regular  and  polished  of  the  primitive  triangles.  This  lumin- 
ous and  incorruptible  body,  which  envelopes  the  immaterial  soul,  was 
placed  in  the  brain  of  man.  The  gods  endowed,  also,  the  visible  and 
grosser  body  of  the  animal  with  another,  mortal  soul,  the  seat  of  the 
violent  and  fatal  passions.  This  occupied  the  length  of  the  spinal  mar- 
row, leaving  between  it  and  the  divine  soul,  the  interval  of  the  neck, 
for  fear  that  the  two  substances,  of  a  nature  so  different,  being  too 
closely  connected,  the  least  pure  might  tarnish  or  embarrass  the  other 
by  its  contact. 

"  Therefore,"  says  the  same  author,  "  the  gods  placed  the  mortal  soul 
in  the  chest  and  the  trunk ;  and  as  this  soul  contains  a  good  and  bad 
principle,  they  divided  the  cavity  of  the  trunk  into  two  departments, 
just  as  is  done  with  the  apartments  of  males  from  females,  by  means  of 
the  diaphragm,  placed  in  the  middle  as  a  partition.  Isearer  the  head, 
between  the  diaphragm  and  the  neck,  they  placed  the  manly  and  coura- 
geous, or  bellicose  principle  of  the  soul ;  so  that  being  submitted  to,  and 
in  concert  with  the  reason,  it  may  restrain  the  revolts  of  the  passions 
and  desires,  when  these  are  unwilling  to  be  controlled  by  the  influences 
which  reason  sends  down  from  its  citadel. 

"  That  portion  of  the  soul  which  requires  food  and  drink,  and  all 
that  the  nature  of  our  body  renders  necessary,  is  located  between  the 
diaphragm  and  the  umbilicus.  The  gods  have  extended  it  over  this 
entire  region,  like  a  rack,  where  the  body  may  find  its  food.  They  have 
confined  it  there,  like  a  ferocious  beast,  which  it  is  necessary,  neverthe- 
less to  feed,  so  that  the  mortal  race  may  subsist. 

"  The  authors  of  the  human  species  having  foreseen  that  we  would 
be  intemperate  in  eating  and  drinking,  and  that  by  gormandizing  we 
should  exceed  very  much  the  limits  of  what  is  proper  and  necessary ; 
therefore,  in  order  to  prevent  us  from  destroying  ourselves  at  once  by 
diseases,  and  for  fear  that  the  race  would  thus  soon  become  extinct,  they 
arranged  what  is  termed  the  lower  bowels,  to  serve  as  a  receptacle  for 
the  superfluous  food  and  drinks,  and  they  surrounded  it  with  the  folds 
of  our  intestines,  for  fear  that  the  aliment,  by  passing  too  rapidly 
through  the  body,  would  create,  too  soon,  the  necessity  for  its  renewal, 


SCHOOLS   OF  THE   ASCLEPIAD^.  151 

which  in  making  us  insatiable  gourmands  would  divert  us  from  the 
cultivation  of  philosophy,  and  the  muses,  and  from  the  obedience  we 
owe  to  that  which  is  Divine,  within  us." 

Plato  enumerates  this  way  the  principal  parts  of  the  body,  and  sup- 
poses that  he  had  sufficiently  explained  the  manner  in  which  each  one 
was  generated,  when  he  announced  its  functioms  ;  or,  to  use  his  own 
expression,  when  he  enumerated  their  final  causes.  But  I  think  I  have 
shown  enough  to  convince  the  reader  of  the  emptiness  and  nothingness 
of  this  kind  of  explanations,  in  the  physical  sciences. 

As  to  the  physiology  of  the  same  author,  it  is  extremely  succinct,  and 
limited  to  some  generalities.  It  emits  no  new  idea,  no  principle,  which 
has  not  been  explicitly  developed  in  the  Hippocratic  works,  with  the 
exception  of  the  idea  of  elementary  triangles,  that  Plato  found  means 
to  bring  in  everywhere.  "The  nature  of  diseases,"  he  says,  "has 
something  in  common  with  that  of  animals.  They  are  developed  within 
a  limited  period,  the  same  as  each  species  ;  each  animal  is  born  to  live 
for  a  certain  determined  period,  barring  the  accidents  that  may  occur ; 
for  the  triangles  which  constitute  each  animal  are  disposed  to  last  for  a 
certain  length  of  time,  beyond  which  the  animal  can  not  survive.  It  is 
the  same  with  diseases  ;  but  if  they  are  disturbed  before  a  fixed  time, 
by  the  employment  of  remedies,  the  smallest  grow  larger,  and  a  single 
one  attracts  many.  It  is  better  to  treat  them  by  regimen,  as  far  as 
possible,  and  not  disturb  them  by  medicines.  Let  this  suffice  for  the 
animal  and  his  corporeal  part." 

In  bringing  out  some  of  the  physico-psychical  naivetes  of  Plato,  I  am 
far  from  desiring  to  cast  ridicule  on  the  conceptions,  sometimes  bold, 
but  always  brilliant,  of  one  of  the  most  splendid  geniuses  of  antiquity. 
1  am  aware  that  seen  in  the  lights  of  his  age,  the  fictions  of  this  philo- 
sopher are  not  as  eccentric  as  they  appear  to  us  at  first  sight,  since  they 
have  been  reproduced  in  many  writings,  in  totality  or  in  part,  almost 
as  far  down  as  our  times  ;  but  I  wish  to  show  by  a  great  example,  in  the 
first  place,  that  the  introduction  of  final  causes  into  Physics  and  Medi- 
cine, has  only  been  a  source  of  deceptions  ;  next,  that  the  purely  specu- 
lative method,  so  exact  and  fruitful  in  mathematics,  has  only  led  to 
futile  dreams,  and  the  play  of  the  imagination,  the  sublimest  minds 
that  have  attempted,  by  this  method,  to  seek  the  properties  of  matter, 
and  the  explanation  of  the  phenomena  of  nature.  This  will  be  more 
and  more  apparent,  as  we  advance  in  this  history,  and  new  examples, 
not  less  illustrious  than  the  preceding,  will  come  to  confirm  this.  I 
will  deduce,  for  the  present,  two  practical  results :  first,  that  it  requires 
above  all  things,  to  choose  a  good  method  by  which  to  acquire  and  culti- 
vate the  sciences ;  second,  that  every  system  of  physics,  or  of  medicine, 


152  PHILOSOPHIC   PERIOD. 

■whicli  does  not  repose  on  accessible  facts,  or  tlie  immediate  appreciation 
of  the  senses,  is,  at  least,  very  hazardous,  for  where  the  senses  can  not 
penetrate,  imagination  reigns  as  sovereign. 

Philosophers  point  out  two  principal  modes  of  acquisition :  the  one. 
which  they  name  logical,  or  rational,  consists  in  establishing,  at  the 
commencement,  some  general  propositions,  or  abstract  principles,  whence 
they  deduce,  by  reasoning,  the  solution  of  all  particular  causes :  thus,  in 
mathematics  is  deducsd  from  the  axiom,  "two  quantities  equal  to  a 
third,  are  equal  to  each  other,"  the  solution  of  a  multitude  of  problems. 
So,  also,  from  the  following  moral  principle,  "  do  unto  others,  as  you 
would  have  them  do  unto  you,"  the  casuist  deduces  a  mass  of  special 
precepts.  Plato,  who  knew  no  other  method,  is  then,  very  excusable  for 
having  pretended  to  derive  an  entire  system  of  cosmology  and  physio- 
logy, from  that  antique  dogma :  the  Supreme  Intelligence  has  ordered 
every  thing  for  the  best  possible  ends." 

The  other  mode  of  acquisition,  called  the  empirical,  or  experimental, 
consists  in  observing,  first,  a  great  number  of  particular  cases  or  phenome- 
na, comparing  them  with  each  other,  and  noting  their  similitudes  and 
differences ;  finally,  to  express  what  they  have  in  common,  by  general 
or  abstract  propositions,  which  constitute  axioms.  In  this  way,  Hip- 
pocrates, having  seen,  time  and  again,  patients  who  had  many  parts  of 
their  body  affected,  yet  complained  of  one  only,  deduced  from  his  obser- 
vations, the  following  aphorism  :  "in  two  simultaneous  pains,  the  more 
intense  obscures  the  other  ;"  and  so  the  natural  philosophers,  having 
observed  that  water  rises  in  the  body  of  a  pump,  in  proportion  as  the 
piston  is  withdrawn,  a  little  too  hastily  concluded  that  nature  abhors  a 
vacuum. 

The  first  method,  it  is  seen,  proceeds  from  generals  to  particulars, 
from  the  abstract  to  the  concrete,  from  the  axiom  to  the  phenomenon  : 
the  second,  on  the  contrary,  advances  from  particulars  to  generals,  from 
the  concrete  to  the  abstract,  from  the  phenomenon  to  the  axiom.  Both 
methods  have  their  advantages,  their  inconveniences,  and  their  proper 
uses.  Far  from  being  opposed  to  each  other,  as  has  been  pretended, 
these  two  methods  fortify  and  enlighten  each  other,  and  the  truth  never 
takes  hold  of  us  in  a  more  irresistible  manner,  than  when  it  is  attained 
by  both  routes  at  once.  Certain  ideologues  have  erroneously  called  the 
first  method,  the  synthetic,  and  second,  the  analytic :  the  words  synthesis 
and  analysis,  employed  in  this  acceptation,  make  nonsense,  as  has  been 
well  remarked  by  a  modern  metaphysician,  and  as  I  shall  demonstrate 
hereafter  myself.--' 

*  See  end  of  the  volume — tlie  doctrine  of  Barthez  on  the  Vital  Principle. 


SCHOOLS  OF  THE   ASCLEPIAD^.  153 

ART.   II.     ARISTOTLE. 

Aristotle  was  bom  at  Stagyrus,  a  city  in  Macedonia.  Having  lost 
his  father  at  an  early  age,  he  was,  though  a  mere  youth,  abandoned  to 
himself,  and  expended  his  patrimony  in  dissipation.  At  first  he  fol- 
lowed the  career  of  arms,  but  soon  becoming  disgusted  with  this  pro- 
fession, he  left  it  to  resume  the  favorite  studies  of  his  early  youth  — 
philosophy  and  medicine. 

The  teachings  of  Plato  at  that  time  shed  a  splendid  influence  ■  over 
Greece.  Young  men  flocked  to  Athens,  from  all  parts,  to  hear  him. 
Aristotle  went  also,  and  showed  himself  one  of  his  most  assiduous  and 
constant  auditors.  His  ardor  in  study  was  incredible  ;  he  consecrated 
to  it  entire  days,  and  a  great  part  of  the  nights.  It  is  said  that  he 
was  obliged,  for  a  living,  to  take  a  place  in  the  shop  an  herbalist,  and 
doubtless  he  gave  medical  advice,  also,  according  to  the  habit  of  the 
pharmacopolists  of  those  times.  Thus,  the  philosopher  of  Stagyrus,  the 
future  chief  of  the  Peripatecian  sect,  belongs  to  the  history  of  Medicine 
in  several  respects,  namely,  by  his  birth,  and  early  education :  for  he 
was  the  son  of  a  physician,  and  received  from  his  father  the  first  ele- 
ments of  science ;  secondly,  by  the  profession  he  practiced  during 
many  years  of  his  life  ;  thirdly,  by  researches  in  comparative  anatomy 
and  physiology  ;  finally,  by  his  philosophic  doctrine,  which  maintained 
its  empire  for  so  long  a  time,  over  every  branch  of  human  knowledge. 

When  Philip,  king  of  Macedonia,  whose  finesse  and  political  discern- 
ment became  proverbial,  wishing  to  give  a  preceptor  to  his  son  Alexander, 
then  fourteen  years  of  age,  fixed  his  choice  on  Aristotle,  and  wrote  to 
him  on  that  occasion  that  well  known  letter,  which  not  less  honors  the 
monarch  than  the  philosopher,  we  all  know  how  well  the  young  prince 
responded  to  the  hopes  of  the  father,  and  the  lessons  of  the  master.  1 
shall  say  nothing  here  of  the  invincible  hero  who  overran  and  con- 
quered Asia ;  but  I  must  not  be  entirely  silent  in  regard  to  him,  as  an 
impassioned  amateur  of  science  and  letters,  who,  in  the  midst  of  the 
embarrassments  of  the  vastest  government  of  the  world,  and  unceasing 
wars,  maintained  with  his  preceptor  a  scientific  correspondence,  and  not 
only  furnished  him  the  necessary  funds  to  foiTQ  the  first  known  museum 
in  natural  history,  but  also  occupied  himself  in  the  collection  of  animals, 
plants,  and  every  sort  of  rare  objects,  which  he  transmitted  to  him  from 
the  depths  of  Asia. 

Thanks  to  the  munificence  of  his  royal  pupil,  Aristotle  was  in  a  con- 
dition to  gather  an  immense  collection  of  the  products  of  nature  —  a 
fruitful  mine  whence  his  genius  drew  an  incredible  mass  of  observations, 
that  antiquity  never  surpassed,  in  many  particulars,  and  which  has 
10 


154  PHILOSOPHIC   PERIOD. 

been  the  astonishment  of  all  ages.  Certain  critics,  not  being  able  to 
explain  how  a  single  man  was  able  to  treat  so  great  a  number  of  sub- 
jects, and  shed  so  much  light  on  the  greater  part,  have  suspected  Aris- 
totle of  having  wickedly  destroyed  the  writings  of  his  predecessors,  so 
as  to  appropriate  their  discoveries  to  himself,  just  as  they  accused  Hip- 
pocrates of  having  set  fire  to  the  temple  of  Cos,  with  the  design  of 
destroying  the  archives  whence  he  had  drawn  the  materials  of  his 
works  —  pure  calumnies,  which  fall  before  the  slightest  examination, 
and  of  which  all  history  has  made  itself  the  eternal  echo.  Every  one 
should  read,  in  the  introduction  to  the  Hippocratic  works  of  M.  Littre, 
the  natural  explanation  that  this  learned  philologer  gives  of  the  loss 
of  a  multitude  of  ancient  works,  without  resorting  to  hazardous  con- 
jectures against  the  best  established  reputations.  But  the  founder  of 
the  Peripatecian  sect,  so  far  from  leaving  unmentioned  the  names  of  the 
authors  who  had  written  before  him  on  the  same  subjects,  quotes  them 
on  nearly  every  page  —  he  often  gives  their  opinions,  and  many  of  them 
are  indebted  entirely  to  his  quotations  for  the  advantage  of  having 
escaped  entire  oblivion. 

The  earliest  philosophers  who  meditated  on  the  origin  of  our  know- 
ledge, or  the  manner  in  which  we  acquire  it,  and  the  degree  of  cer- 
tainty which  it  offers,  were  greatly  shocked  at  the  frequent  and  gross 
errors  into  which  we  are  drawn  by  the  senses,  while  they  were  agreeably 
surprised,  and  marvelled  at  the  character  of  infallibility  that  certain 
abstract  truths  presented,  and  particularly  those  that  belong  to  mathe- 
matics. To  give  only  one  example  of  this  contrast,  but  one  which  is 
everywhere  known,  do  not  the  most  remote  astronomical  observations 
demonstrate  that  the  sun  and  the  moon  have,  in  reality,  dimensions  enor- 
mously greater  than  their  objective  appearance  would  lead  us  to  suppose  ? 
From  this  example,  and  an  infinity  of  similar  ones,  philosophers  drew 
this  general  indication,  that  the  senses  transmit  false,  doubtful,  or 
illusory  impressions,  and  that  the  soul,  to  attain  the  possession  of  truth 
and  certainty,  must  isolate  itself  as  much  as  possible  from  the  inter- 
vention of  the  body,  and  reflect  within  itself.  Hence  arose  the  contem- 
plative philosophy  that  Pythagoras  recommended  in  secret  to  his  dis- 
ciples, and  which  Plato  taught  publically,  with  all  the  prestige  of  his 
imagination  and  eloquence. 

Nevertheless,  men  who  devoted  themselves  to  the  study  of  physical 
phenomena,  physicians,  above  all  others,  could  not  question  the  neces- 
sity of  the  intervention  of  the  senses,  to  obtain  a  faithful  image  of  these 
phenomena.  Daily  experience  demonstrated  to  them  how  vain  are  the 
anticipated  conceptions  of  the  mind  touching  the  operations  of  nature. 
Each  day  new  deceptions  came  to  lead  them  to  mistrust  the  principles 


SCHOOLS   OF   THE   ASCLEPIAD^.  155 

established  a  priori ;  for  these  principles  conducted  them  to  conse- 
quences that  the  facts  frequently  contradicted.  Thus,  we  have  found 
in  the  Hippocratic  collection,  authors  who  proclaim  the  necessity  of 
banishing  from  medicine  all  hypothesis,  and  holding  to  immediate  observ- 
ation only ;  authors  who  say  that  there  is  no  fixed  principle  of  treat- 
ment; that  the  cure  of  diseases  is  efibcted  sometimes  by  contraries, 
sometimes  by  similars,  and  sometimes  in  other  ways,  without  our  being 
able  to  say  in  virtue  of  what  principles.-'  These  are,  evidently,  empiri- 
cal maxims,  but  mere  isolated  ones,  simple  perceptions,  which  consti- 
tute neither  a  system  nor  a  method. 

It  was  reserved  for  the  greatest  naturalist  of  antiquity  to  lay  the 
first  philosophic  basis  of  empiricism ;  Aristotle,  in  emitting  his  famous 
axiom,  "  all  ideas  come  from  the  senses,"  {nihil  est  in  intellectu  quod  non 
prius  faerit  in  sensu,)  introduced  into  science  a  new  principle,  in  mani- 
fest contradiction  to  the  revered  dogmas  of  Pythagoras  and  Plato.  It 
is,  then,  very  important  to  know  how  the  chief  of  the  Peripatecians 
would  justify,  from  the  beginning,  the  bold  principles  which  became,  two 
thousand  years  later,  the  germ  of  a  scientific  revolution. f 

We  read,  in  the  treatise  on  Analysis,  "  It  appears  that  all  animals  have 
received,  from  nature,  the  faculty  of  sensation  and  judgment ;  but  after  a 
sensation  has  been  produced,  some  preserve  the  remembrance  of  it,  and 
others  do  not.  Those  who  retain  no  reminiscence  of  the  impressions,  have 
no  idea  of  the  things,  beyond  immediate  sensations.  Those,  on  the  con- 
trary, whose  soul  retains  some  trace  of  passed  sensations,  can,  at  the 
end  of  a  great  number  of  such,  reason  from  the  recollection  which  they 
keep  of  them.  In  this  way,  the  memory  comes  from  the  faculty  of  feel- 
ing. The  remembrance  of  a  thing  often  repeated  creates  experience,  and 
experience,  that  is  to  say,  every  general  notion  which  becomes  fixed  in 
the  soul,  relative  to  the  common  properties  of  certain  things,  abstrac- 
tion made  from  their  difierences — this  notion,  I  say,  is  the  principle  of 
science  and  art."| 

In  another  work,  the  philosopher  of  Stagy rus  recalls  the  distinction 
that  he  has  just  established  between  animals  which  have  memory,   and 

^Traite  des  Lieux  dans  I'Homme.     Traite  de  I'Ancienne  Me'decine. 

fThis  principle  was  not  entirely  new,  since  Plato  makes  allusion  to  it  in  the 
passages  we  have  cited,  when  he  asks  himself  if  it  is  not  the  brain  that 
produces  all  our  sensations,  "  which  produce,  in  their  turn,  the  imagination  and 
memory,  whose  operations  at  last  develop  science."  But  Plato  scarcely  deigned 
to  pause  and  consider  the  opinion,  while  Aristotle  adopted  and  developed  it. 

JAristotelis  Opera  Omnia  quae  extant  Grajce  et  Latine.  Authore  Guiilemo 
Duval.  Lutitise  Parisiorum,  anno  M.  DC.XIX.  Analyticorum  posteriorum,  lib. 
n,  cap.  XIX. 


156  PHILOSOPHIC   PERIOD. 

those  whicli  have  not ;  he  adds,  that  the  first  are  susceptible  of  educa- 
tion, while  the  others  possess  instinct  only.  Finally,  he  says  that  man 
alone  is  capable  of  instruction  and  reason  ;  after  which  he  continues  in 
these  terms :  "To  deduce,  from  a  great  number  of  experiments,  a  uni- 
versal idea  on  an  entire  class  of  similar  objects,  this  constitutes  art. 
Thus,  to  possess  the  knowledge  that  a  remedy  has  been  useful  in  a  certain 
disease,  in  the  hands  of  Callias,  Socrates,  and  several  others,  is  experi- 
ence ;  but  to  know  that  such  a  remedy  is  good  for  all  individuals  of  the 
same  species,  attacked  by  a  given  affection,  for  example,  for  all  men 
who  are  tormented  with  phlegm,  bile,  or  a  hot  fever,  this  is  what  con- 
stitutes art.  "'••■= 

Might  not  we  believe,  in  reading  these  fragments,  that  they  are  ex- 
tracted from  some  chapter  of  the  modern  school  of  sensualists  ?  How 
then  does  it  come  that  Condillac,  one  of  the  coryphas  of  this  school, 
could  write  the  following  lines  :  "  Long  ago  it  was  said  that  all  our 
knowledge  originated  in  the  senses.  Nevertheless,  the  Peripatecians 
were  so  far  from  knowing  this  truth,  that  notwithstanding  the  minds  of 
several  had  appreciated,  they  were  unable  to  develop  it ;  so  that  for 
several  ages  afterward  it  was  still  a  discovery  to  be  made.  I  am  igno- 
rant of  the  motive  of  Aristotle,  when  he  advanced  his  doctrine  on  the 
origin  of  human  knowledge ;  but  I  do  know  that  he  has  left  no  work  in 
which  this  doctrine  is  developed,  and  that,  besides,  he  sought  to  be  in 
everything  the  opposite  of  the  opinions  of  Plato."  f 

The  best  excuse  that  can  be  given  for  the  epigrammatic  insinuation  of 
this  last  phrase  of  Condillac  is,  that  he  had  never  read,  or  had  com- 
pletely forgotten  the  passages  of  Aristotle  that  I  have  quoted  above. 
There  arc  yet  other  discoveries,  claimed  by  moderns,  the  germs  of  which 
are  found  in  the  writings  of  this  prince  of  ancient  philosophers.  The 
philosophic  doubt,  for  example,  which  forms  one  of  the  pillars  of  the 
method  of  Descartes,  is  clearly  indicated  by  Aristotle,  when  he  says. 
"Men  who  desire  to  learn,  must  previously  know  how  to  doubt;  for 
science  is  only  the  resolution  of  previous  doubts ;  but  he  who  does  not 
know  the  knot  is  unable  to  untie  it."  J  The  doubt  that  Aristotle  has 
recommended  is  very  different,  as  is  plain,  from  that  which  the  Pyrrhor- 
nian  or  Zetetique  sect  professed.  The  latter  regarded  doubting  as  the 
highest  degree  of  science  ;  the  Peripatecian,  on  the  contrary,  saw  only 
in  it,  the  first  step  toward  the  light — a  simple  disposition  of  the  soul 
to  elevate  itself  to  the  intelligence  and  demonstration  of  the  truth. 

*Opera  Omnia,  Metaphys.,  lib.  i.  cap.  i. 

t  (Euvi'es  completes  cle  Condillac — analytical  extract  from  the  Traite  des  Sensa- 
tions.    Paris,  1798. 

I  Metaphys.,  liv,  ui.,  chap.  i. 


SCHOOLS   OF  THE   ASCLEPIAD^.  157 

Having  thus  established  clearly  the  claims  of  Aristotle,  as  the  founder 
of  the  sensualist  or  experimental  doctrine,  it  remains  to  show  in  what 
particular  he  afterward  separated  himself  from  the  doctrine,  and  esta- 
blished a  method  diametrically  opposite  to  that  of  modern  sensualists. 
To  show  this  I  will  recall  the  second  axiom  emitted  by  this  philosopher, 
on  the  development  of  ideas.  "  The  first  ideas,"  he  says,  "  that  the 
sensations  create  in  our  minds,  are  general  ones."  Here,  we  observe. 
the  ancient  school  of  the  sensualists  is  entirely  separated  from  the 
modern,  and  here,  also,  commences  their  antagonism.  It  is,  then,  essen- 
tial to  examine  upon  what  considerations  Aristotle  rests,  in  advancing 
such  a  maxim.  He  involves  in  the  support  of  this  proposition,  the  case 
of  a  man,  who,  perceiving  at  a  great  distance  an  opaque  mass  of  vague 
or  undetermined  forms,  conceives,  at  first,  the  general  idea  of  some  kind 
of  a  body.  Then,  as  he  approaches  this  mass,  and  sees  it  moving  auto- 
matically, he  conceives  the  idea  of  an  animal ;  then,  finally,  when  he  is 
near  enough,  he  will  not  only  recognize  of  what  species  this  animal  is, 
but,  also,  if  he  gives  attention  to  certain  marks,  and  particular  quali- 
ties, he  will  be  able  to  distinguish  it  from  every  other  individual  of  the 
same  species  ;  in  this  way  he  obtains  his  individual  ideas.  It  is  thus, 
according  to  this  philosopher,  that  the  human  mind  advances  from  the 
most  general  notions,  to  those  that  are  particular  and  individual.  He 
also  cites  the  example  of  a  little  child,  who  calls  all  men  papa,  and  all 
women  mamma  ;  but  as  he  grows,  his  ideas  become  special,  and  he  learns 
to  discern  his  father  and  mother  from  all  other  persons.'-- 

The  argument  of  Aristotle  is  captious,  and  may  deceive  mere  than 
one  reader.  It  will  not,  then,  be  out  of  place,  I  think,  to  recall  here 
the  manner  in  which  Locke,  one  of  the  chiefs  of  the  modern  school  of 
sensualists,  explains  the  succession  of  our  ideas,  and  the  progress  of  our 
knowledge.  "  The  ideas,"  says  this  writer,  "  which  children  form  of 
persons  with  whom  they  are  familiar,  arc  similar  to  the  persons  them- 
selves, and  are  only  special  ones.  The  ideas  they  have  of  their  nurses 
and  mothers,  are  very  well  defined  in  their  minds,  and,  as  so  many  faith- 
ful pictures,  represent  to  them  only  those  individuals.  The  names  that 
they  give  them,  at  first,  are  limited  to  them  ;  thus  the  names  of  nurse 
or  mamma,  which  children  employ,  are  CQnnected  entirely  to  these  per- 
sons. But  after  they  acquire  a  greater  knowledge  of  things,  and  observe 
that  there  are  several  other  beings,  who,  in  respect  to  figure,  and  other 
particulars,  resemble  their  fathers,  mothers,  and  other  persons  that  they 
arc  accustomed  to  see,  they  form  an  idea  which  includes,  also,  these 


*^  Aristotle,  On  Analysis,  2e  partie,  chap,  ii  and  xix.     Natural  Principles,  lir. 
I,  chap.  I ;  and  in  several  other  books. 


158  PHILOSOPHIC   PERIOD. 

particular  beings,  and  they  call  them  with  all  others,  men.  In  this  way 
he  obtains  a  general  name,  and  a  general  idea.  In  doing  so,  however, 
they  form  nothing  new,  but  separating  themselves  from  the  complex 
idea  they  had  of  Peter,  of  James,  Mary,  and  Elizabeth,  and  which  was 
particular  to  each  of  them,  they  retain  what  is  common  to  them  all."  =•■' 

The  last  two  quotations,  one  taken  from  the  writings  of  Aristotle,  the 
other  from  those  of  Locke,  oflFer  us  the  curious  spectacle  of  two  meta- 
physicians, who,  starting  with  the  same  principle,  that  all  ideas  are 
derived  from  the  senses,  separated  immediately,  to  follow  opposite  routes : 
the  one  pretending  that  the  first  ideas  formed  in  our  minds,  by  the  inter- 
vention of  the  senses,  are  general  ones  ;  the  other  affirming  that  they 
are  always  individual  in  their  character.  But  it  is  easy  to  see,  that 
Aristotle,  in  the  sample  that  he  gives,  confounds  obscure,  vague,  and 
undetermined  ideas  with  general  ideas,  which  is  a  grave  mistake,  and 
scarcely  conceivable  on  the  part  of  such  a  logician  as  he.  Thus,  when 
I  say,  that  the  whole  is  greater  than  any  one  of  its  parts,  I  express  a 
general  idea  very  clearly ;  instead  of  that,  if  I  perceive  an  object  very 
distant,  not  being  able  to  distinguish  its  form,  I  have  only  an  individual 
idea,  and  that  vague  and  confused.  This  divergence,  so  slight  in  appear- 
ance, and  nearly  imperceptible  at  first  sight,  nevertheless,  misled  in  a 
very  unfortunate  manner,  the  philosopher  of  Stagyrus,  and  plunged  him 
into  an  inextricable  labirynth  of  sterile  subtilties.  Let  us  follow  him 
for  a  few  moments,  in  this  mistaken  route,  and  see  where  he  ends,  rela- 
tive to  the  physical  and  medical  sciences. 

From  the  moment  our  philosopher  believed  he  had  proved  incontestibly, 
that  general  ideas  are  the  first  that  are  formed  in  the  human  under- 
standing, he  deduced  from  it  the  conclusion,  that  the  study  of  all  the 
sciences  must  commence  in  generalities,  or  axioms,  which  he  named  on 
that  account,  principles  or  elements,  and  then  must  pass  to  particular 
or  individual  notions — to  the  phenomena.  So,  after  having  assigned  to  our 
ideas  an  origin,  entirely  diiFerent  from  Plato,  he  proceeds  to  advise  the 
same  didactic  method,  the  same  mode  of  acquisition  that  he  does.  Apply- 
ing this  erroneous  method  to  the  study  of  physics,  Aristotle  commences 
by  asking  how  many  principles  there  are  in  nature.  He  exhibits  all  the 
opinions  emitted  before  him  on  this  thorny  subject,  and  after  having 
discussed  them,  one  by  one,  he  ends  with  the  following  conclusion,  which 
I  translate  literally :  "  Every  body  knows  that  the  principles  or  elements 
exist  in  antagonism,  and  it  is  perfectly  reasonable ;  for  principles  can 
not  produce  each  other,  nor  be  produced  by  any  thing ;  every  thing,  on 

'^  Locke's  Essay  on  the  Human  Understanding,  book  iii,  cliap.  in,  §  7.  See 
also  Condillac,  Essai  sur  I'Oriuine  de  nos  Conuaissance,  sec.  5. 


SCHOOLS   OF  THE  ASCLEPIADiE.  159 

the  contrary,  proceeds  from  them.  Thus,  we  have  exhibited  what  forms 
the  essence  of  first  oppositions — on  the  one  hand,  they  proceed  from 
nothing,  being  original ;  on  the  other,  they  do  not  mutually  produce 
each  other,  becaus:-  they  are  antagonistic.-' 

Immediately  after,  he  proves,  by  an  argumentation  of  the  same  force 
that  natural  principles  are  in  number,  two  or  three,  namely,  the  opposi- 
tion of  heat  and  cold,  of  dryness  and  moisture,  and  finally,  the  base,  or 
the  subject  on  which  these  two  primitive  oppositions  must  exercise  their 
energy,  to  which  he  gives,  in  another  place,  the  name  of  ether. 

Aristotle  admits,  moreover,  four  elements,  fire,  air,  earth,  and  water. 
which  he  believes  susceptible  of  mutual  transmutation,  and  whose  laws 
he  describes.  Above  them,  in  the  most  elevated  zone  of  the  heavens, 
floats  a  fifth  element,  so  called,  because  it  moves  rapidly,  and  eternally 
in  a  circle.  This  was  the  first  and  most  divine  of  all  the  elements,  the 
only  one  which  is  imponderable,  and  immutable  ;  the  only  one  which 
was  original  in  its  character,  being  the  ofi"spring  of  none,  and  yet  the 
basis  of  all."f 

"We  have  seen  that  Plato  endeavored  to  explain  all  the  phenomena  of 
nature,  by  the  consideration  of  final  causes  only ;  but  Aristotle,  who 
piqued  himself  on  being  more  exact,  assigned  to  each  phenomenon,  four 
causes,  namely,  the  material,  formal,  efficient,  and  final.  Thus,  the  clay 
which  the  potter  uses  to  fabricate  a  vase,  is  the  material  cause  of  that 
vase ;  the  model,  or  mould  after  which  he  forms  it,  the  formal  cause ; 
the  potter  himself  the  efficient  cause ;  and  lastly,  the  purpose  for  which 
it  is  destined,  the  final  sause.J 

If  some  of  my  readers  find  these  details  on  the  Peripatecian  philoso- 
phy a  little  too  technical — if  they  do  not  comprehend  what  utility  the 
remembrance  of  these  subtile  and  superannuated  distinctions  can  have 
for  medical  men  of  our  times,  I  pray  them  to  consider  that  the  greater 
part  of  the  writings  of  the  ancient  and  middle  ages  are  more  or  less 
imbued  with  them ;  so  that  it  would  be  impossible  to  read  those  writ- 
ings, and  particularly  the  history  of  medicine,  without  having  at  least 
a  superficial  notion  of  the  doctrine  of  Aristotle ;  for  the  medical  theory 
of  Gralen,  which  has  reigned  in  the  schools  down  to  our  own  era,  is  a 
patent  deduction  from  it.  With  this  short  digression,  I  pass  to  consider 
matters  which  have  a  connection,  more  or  less  direct,  with  medicine. 

Faithful   to    his    method   of    commencing    by  principles,    Aristotle 

"CEuvres  d'Aristotle,  Des  Principes  Naturel,  liv.  i,  chap.  vi. 

f  Aristotle,  Traite  tlu  ciel,  liv.  i,  chap,  ii,  iii,  liv.  iv,  chap,  v ;  also  in  Traite  de 
la  Generation,  et  de  la  Corruption,  liv.  ii,  chap.  iv. ;  also  on  Traite  des  Me'teores, 
liv.  I,  chap.  in. 

I  Aristotle.    Des  Principes  Naturel,  liv.  11,  chap,  ni.,  et  suiv. 


160  PHILOSOPHIC   PERIOD. 

approaches  physiology  in  the  most  obscure  manner.  He  inquires,  in  the 
first  place :  What  is  the  nature  of  the  soul — what  are  its  faculties  and 
functions  ?  To  his  view,  the  soul  constitutes  the  essence  of  all  living 
bodies,  vegetable  and  animal.  It  is  simple,  indivisible,  and  resides  in 
whole  in  each  part  of  the  organized  being,  as  one  may  assure  himself, 
he  says,  by  dividing  a  plant,  and  even  certain  animals,  called  insects : 
for  after  the  division,  the  separate  parts  continue  to  have  the  same  life 
as  the  whole  structure,  which  proves  that  each  of  them  contains  the 
soul  integrally.^"-' 

The  soul  is  endowed  with  four  primitive  faculties,  viz :  the  nutritive, 
or  vegetative,  the  sensitive,  motive,  and  intellectual.  The  first  three 
reside  equally  in  all  parts  of  the  body,  and  they  are  inseparable.  The 
last  one — that  is  to  say,  the  intellectual  or  contemplative — being  of  a 
difi'erent  species,  must  have,  says  our  physiologist,  a  distinct  and  par- 
ticular seat.  Aristotle  does  not  say  positively  where  its  locality  is,  but 
we  may  infer,  from  various  passages  in  his  writings,  that  he  regarded 
the  heart  as  the  special  residence  of  the  intelligent  soul.f 

The  vegetative  faculty  presides  over  nutrition  and  reproduction.  It 
is  indispensable  to  all  things  that  are  born,  live,  and  die,  and  is  common 
to  plants  and  animals.  The  sensitive  faculty,  on  the  contrary,  exists 
only  in  the  latter,  of  whom  it  constitutes  the  essence.  Vegetables  are 
deprived  of  it,  because  they  are  formed  of  only  homogeneous  parts ; 
that  is  to  say,  they  originate  from  one  element  alone,  whilst  animals  are 
formed  of  organic  parts,  i.  e.,  are  composed  of  various  elements. 
Among  animals,  there  are  some  which  have  the  faculty  of  locomotion  ; 
others  are  deprived  of  this ;  and  lastly,  according  to  him,  a  very  small 
number  of  the  animal  species  appear  to  be  endowed  with  intelligence 
and  reason. J 

This  physiologist  had  no  distinct  notion  of  the  locomotive  apparatus ; 
moreover,  he  confounded  the  tendons  and  ligasnents  with  the  nerves,  as 
we  shall  show  presently,  and  he  designated  the  muscles  by  the  term 
flesh.  § 

He  places  the  principle  of  the  motive  faculty  in  the  centre  of  the 
body,  for  the  reason  that,  in  every  object  that  moves,  it  is  necessary 
that  there  be  a  fixed  and  immovable  point  which  shall  serve  to  sustain 
all  the  other  parts,  and  give  them  impulse.  || 

See  how  the  desire  to  give  a  reason  for  every  thing  may  lead  minds  of 
the  keenest  perception  to  offer  words  void  of  sense,  for  veracious  and 

"  Traite  de  I'ame,  livre  i,  cli.  ix.  |  Aristotle.     On  the  Soul, 

f  Sprengle.     History  of  MeJicine.  ||  Du  movement  des  Animaux. 

§De  la  Locomotion.     Histoire  des  Animaux. 


SCHOOLS   OF  THE   ASCLEPIADJG.  161 

grave  explanation !  We  have  already  seen  examples  of  this,  and  we 
shall  see  many  more  in  the  course  of  this  history.  In  place  of  observ- 
ing carefully  the  natural  phenomena,  and  describing  them  with  the 
greatest  possible  exactness,  man  always  seems  to  prefer  to  carry  his 
judgment  beyond  sensations;  and  this  is  the  source  of  the  greatest 
errors  in  the  domain  of  physics.  Aristotle  regards  heat  and  humidity 
as  the  two  conditions  indispensable  to  life;  the  duration  of  which, 
according  to  him,  is  generally  proportionate  to  the  volume  of  the  fluids. 
It  is  on  this  account,  he  adds,  that  large  animals  live  longer  than  small 
ones.  That  rule,  however,  is  subject  to  many  exceptions,  of  which  the 
author  himself  cites  examples ;  but  he  is  not  embarrassed  to  explain 
them.^' 

He  had  no  idea  of  the  true  functions  of  the  brain,  though  he  describes 
that  viscus  much  more  minutely  than  any  of  his  predecessors.  The  fol- 
lowing are  his  remarks :  "  That  which  is  first  found  in  opening  the  head, 
is  the  brain,  and  it  is  placed  in  the  anterior  part.  All  animals  possess- 
ing a  brain,  that  is  to  say,  all  those  which  have  blood,  as  well  as  those 
of  the  order  of  molusca,  have  it  generally  placed  in  the  same  position ; 
but  the  brain  of  man  is  much  more  considerable  than  that  of  other  ani- 
mals, proportionably  to  the  size  of  his  body,  and  is  also  the  most  humid. 
The  brain  is  enveloped  in  two  membranes ;  that  nearest  to  the  cranium 
is  the  strongest — the  other,  which  rests  immediately  upon  it,  is  weaker. 
The  brain  is  always  composed  of  two  lobes,  independently  of  the  cere- 
bellum, which  lies  beneath,  and  whose  form  and  structure  differ  from 
that  of  the  brain.  There  is  usually  a  little  cavity  in  the  middle  of  the 
mass  of  the  brain ;  its  substance  is  naturally  cold  to  the  touch,  and 
neither  veins  nor  blood  are  ever  found  in  its  interior ;  but  the  membrane 
which  envelopes  it  is  full  of  veins. f 

There  is  nothing  in  all  this  which  refers  to  the  elevated  functions  of 
the  encephalic  organ.  Aristotle  did  not  even  suspect  them;  for  he 
places,  as  we  have  just  seen,  the  seat  of  the  soul  and  of  sensation  in 
the  heart. 

Nor  did  he  know  better  the  functions  of  the  nervous  system,  what- 
ever Sprengle,  the  historian,  may  say,  who  attributes  to  him  very  gratui- 
tously, in  my  opinion,  the  discovery  of  that  apparatus. J 

Let  every  one  judge  by  the  following  extract :  "  Let  us  speak  now  of  the 
nerves,"  says  the  Greek  naturalist;  "  they  proceed  also  from  the  heart, 

"De  la  longueur  et  de  la  brievete  de  la  vie,  chap.  v.  De  la  jeunesse  et  de  la 
vieillesse,  de  la  vie  et  de  la  mort,  chap.  iv. 

f  Histoire  des  Animaux,  trud.  by  Camus,  Paris,  1783. 

I  Sprengle,  Histoire  de  la  Medicine,  translated  into  French  by  Jourdan.  Paris, 
181.5,  T.  I,  p.  384. 


162  PHILOSOPHIC   PERIOD. 

that  viscus  containing  nerves  in  its  structure — in  its  largest  cavities ; 
and  what  is  termed  the  aorta  is  a  nervous  vein,  whose  extremities  are 
nothing  else  than  nerves.  At  the  points  where  these  extremities  termi- 
nate around  the  joints  of  bones,  they  are  not  hollow,  and  are  suscep- 
tible of  the  same  tension  as  the  actual  nerves.  But  the  difference 
between  the  nerves  and  the  veins  is,  that  the  nerves  do  not  proceed 
without  interruption,  from  one  unique  substance  to  all  parts  of  the  body, 
like  the  veins.  The  nerves,  on  the  contrary,  are  distributed  on  all  sides, 
and  to  the  articulations  of  the  bones.  If  they  proceeded  from  the  same 
trunk,  their  continuity  would  be  apparent  in  emaciated  animals." 

"  The  principal  nerves  are  those  of  the  ham,  on  which  depend  the 
power  of  leaping ;  then  another  double  nerve,  called  the  tendon ;  then 
the  extensor  and  the  nerve  of  the  shoulder,  which  contribute  to  the 
strength  of  the  body.  No  particular  name  is  given  to  the  nerves  which 
belong  to  the  articulations,  because  all  articulations  of  the  bones  are 
bound  together  by  the  nei'ves.  In  general,  the  nerves  are  found  in 
great  abundance  around  the  bones,  except  the  bones  of  the  head,  which 
are  united  by  sutures."  " 

It  is  evident  that  in  this  entire  description,  Aristotle  describes,  under 
the  name  of  nerves,  only  tendons  and  ligaments.  But  Sprengle  formed 
his  opinion  on  the  following  paragraph:  "In  the  space  between  the 
eyes  we  find  three  canals  which  go  to  the  brain ;  the  largest,  the  middle 
one,  proceeds  to  the  cerebellum ;  and  the  smallest,  the  one  which  is  near- 
est the  nose,  leads  to  the  brain.  "| 

He  infers  from  this  phrase,  that  very  probably  Aristotle  had  observed 
the  optic  and  olfactory  nerves  in  fish,  where  they  follow  this  direction. 
"Whether  or  not  this  naturalist  has  observed  a  few  nerves,  it  is  never- 
theless certain  that  he  did  not  at  all  infer  their  functions. 

Aristotle  is  rich  enough  in  his  own  merits,  without  needing  to  be 
adorned  with  the  plumes  of  others.  No  man  in  antiquity  studied  and 
searched  out  more  things  than  he,  and  no  one  introduced  into  science  so 
many  new  facts.  To  keep  to  our  subject,  we  assert  that,  though  he 
never  dissected  human  corpses,  he  nevertheless  corrects  many  errors 
on  the  anatomy  and  physiology  of  man,  in  the  Hippocratic  collection. 
For  example,  he  refutes  the  opinion  of  Polybius,  who  supposed  that  the 
veins  commence  at  the  occiput,  from  which  they  descend  in  pairs  the 
length  of  the  anterior,  lateral,  and  posterior  surfaces  of  the  body ;  he 
asserts  that  they  originate  at  the  head.      He  combated  also  the  opinion 

'■•■  Aristotle,  History  of  Animals,  livre  in,  chap.  v. 

f  Sprengle,  History  of  Medicine,  t.  I,  p.  38.  Aristotle,  History  of  Animals, 
livre  I,  chap.  xvi. 


SCHOOLS   OF  THE   ASCLEPIAD^.  163 

that  a  part  of  the  fluids  drank  went  directly  to  the  lungs,  for  the  pur- 
pose of  cooling  them." 

As  he  had  dissected  a  considerable  number  of  animals  of  every  spe- 
cies, he  compares,  with  a  sagacity  astonishing  for  his  era,  the  organic 
apparatus  by  means  of  which  each  of  them  lives,  propagates,  and  fulfills 
the  various  functions  to  which  it  is  destined.  In  speaking  of  the  heart, 
for  instance,  he  signalized  the  varieties  of  form  and  structure  that  this 
organ  presents  amongst  quadrupeds,  birds,  reptiles,  fishes,  etc.  He  does 
the  same  in  regard  to  the  digestive  tube,  the  lungs,  and  the  other  organs 
successively.  He  does  not  group  together,  according  to  the  method  of 
naturalists,  all  the  characters  that  appertain  to  the  same  species  of  ani- 
mal, so  as  to  distinguish  each  of  them  from  all  the  others ;  yet  his  method 
is  not  less  philosophic  nor  less  fruitful  in  interesting  ideas ;  he  presents 
the  history  of  each  apparatus  of  each  organic  function  successively,  and 
shows  the  varieties  and  shades  in  the  whole  range  of  the  animal  scale. 
In  a  word,  he  created  comparative  anatomy  and  physiology ;  and  the 
plan  that  he  traced  is  so  appropriate  to  the  subject,  that,  twenty  centu- 
ries later,  George  Cuvier  did  not  choose  another. 

If  the  founder  of  the  Peripatecian  sect  can  be  reproached  for  hav- 
ing propagated  a  taste  for  scholastic  subtilties,  it  must  be  acknowledged 
also,  that  he  has  furnished  an  example  of  patient  and  attentive  observa- 
tion of  nature.  His  history  of  animals  is  a  treasure  of  curious  details 
on  the  manners  and  habits  of  that  class  of  beings,  their  modes  of  fecun- 
dation and  incubation,  and  their  diseases.  His  disciples,  excited  by  his 
example  and  his  counsels,  cultivated  with  a  praiseworthy  zeal,  anatomy, 
physiology  and  natural  history.  Theophrastus,  his  successor,  was  the 
most  eminent  botanist  of  antiquity.  Their  reputation  in  that  class  of 
studies,  was  so  well  established,  that  an  ancient  satirist  makes  Mer- 
cury say,  in  showing  a  Peripatecian,  whom  he  wishes  to  sell, 
"  behold  a  man  who  can  tell  you,  in  a  moment,  the  duration  of  the  life 
of  a  fly ;  to  what  depth  the  rays  of  the  sun  penetrate  the  sea  ;  and  what 
is  the  nature  of  the  soul  of  an  oyster  ;  he  will  recount  to  you,  a  quantity 
of  other  things,  more  difficult  still,  on  the  semen,  generation,  and  the 
manner  in  which  the  fetus  is  formed  in  the  womb  of  the  mother,  "f 

Plato  and  Aristotle  were  among  the  ancients,  the  most  eminent 
propagators  of  two  antagonistic  opinions,  that  have  divided  philosophers, 
from  the  origin  of  science.  One  of  these  opinions  supposes  all  our 
knowledge  to  be  derived  from  mental  intuition,  without  the  intervention 

'^  History  of  Animals. 

fLuciani  Opera — towards  the  end  of  the  dialogue  entitled,  Vitarum  Anctio ;  p. 
108,  edition  of  Bourdelat.     Paris,  1605. 


164  PHILOSOPHIC   PERIOD. 

of  the  senses ;  the  other  claims  that  all  our  ideas  are  due  to  sensations. 
We  shall  see  these  two  scientific  methods,  so  to  speak,  parallelly  increase, 
and  become  more  perfect,  without  either  obtaining  any  decided  preemi- 
nence over  its  rival.  Both  count  amongst  moderns,  partisans  of  the 
highest  intelligence.  It  will  suffice  to  name  Descartes,  Leibnitz,  and 
Kant,  for  the  spiritual  school,  and  Bacon,  Locke,  Hume,  and  Condillac. 
for  the  sensualist  school.  We  shall,  in  the  course  of  this  history,  make 
it  our  duty  to  study,  and  compare,  seriously,  the  opinions  and  methods 
professed  by  both  of  these  schools,  being  well  convinced  that  it  would 
be  neither  just  nor  reasonable,  to  agree,  exclusively,  with  the  dogmas  of 
either,  before  diligently  examining  the  teachings  of  both ;  and  if  my 
confreres  in  medicine  accuse  me  of  separating  myself  from  my  subject, 
by  according  too  much  space  to  the  examination  of  medical  philosophic 
methods,  I  reply  in  this  aphorism  of  the  most  learned  interpreter  of  the 
doctrine  of  Cuvier :  "  the  first  question  in  all  science,  is  always  a  question 
of  method." 

RESUME   OF    THE   PRIMITIVE    PERIOD. 

During  the  short  period  through  which  we  have  just  passed,  we  have 
seen  medical  science,  stripped  of  its  mystic  veil,  take,  suddenly,  a  rapid 
bound.  The  principal  foundations  of  its  edifice  have  been  laid,  and  we 
see  appear  an  outline  of  each  of  its  parts,  which  is  to  form,  at  a  later 
period,  a  vast  structure — an  outline  whose  totality  offers  already  an 
imposing,  although  somewhat  vague,  aspect.  "  Antique  science,"  as  M. 
Littre  most  eloquently  says,  "  has  a  great  resemblance  to  modern  science. 
From  the  epoch  which  we  are  forced  to  regard  as  the  aurora  of  medicine 
— from  the  first  memorials  that  we  possess  of  it,  the  fundamental  ques- 
tions are  debated,  and  the  limits  of  the  human  mind  are  touched.  But 
within  these  limits,  science  finds  an  immensity  of  inexaustible  combi- 
nations, the  materials  for  its  growth."* 

This  remark  is  as  true  of  philosophy,  as  of  medicine.  Plato  and 
Aristotle  indicate  to  us  two  sources  whence  flow  all  our  natural  knowl- 
edge ;  but  do  not  both  of  them  lead  us  into  error,  by  proclaiming  in  an 
exclusive  manner,  as  a  mode  of  acquisition,  the  one  mental  intuition, 
the  other  exterior  observation  ? 

Hippocrates  forms  the  transition  period  between  the  preceding  periods 
and  this ;  he  belongs  equally  to  mythology  and  history ;  for,  if  some 
circumstances  of  his  life,  and  some  of  his  works  are  authentic,  the 
greater  part  are  doubtful,  or  controverted.  His  doctrine  was  received 
by  his  cotemporaries,  and  by  posterity,  with  a  veneration  which  resem- 

'■' (Euvres  d'Hippocrate.     Paris,  1839.    lutroduction,  p.  567. 


SCHOOLS   OF  THE  ASCLEPIADiE.  165 

bles  a  worship,  no  less,  probably,  on  account  of  the  real  merit  of  his 
doctrines,  than  by  reason  of  the  mystery  which  shrouds  his  birth.  After 
him,  no  physician  has  ever  obtained  an  homage  so  elevated,  so  constant, 
and  so  universal.  Very  soon,  anarchy  prevailed  in  the  midst  of  the 
school  which  he  had  rendered  celebrated ;  a  crowd  of  methods  and  theo- 
ries were  surreptitiously  propagated  there,  under  the  shadow  of  his 
name  and  authority ;  so  much  so,  that  as  a  result,  it  became  impossible 
to  discern,  in  the  midst  of  so  many  writings  and  facts,  placed  to  his 
account,  what  was  really  legitimate  of  all  that  was  imputed  to  him. 

Medical  science,  in  changing  its  locality,  proceeds  also  to  change  its 
aspect.  After  a  few  years  of  confusion,  we  shall  see  medical  men  divided 
into  three  great  sects,  which  will  struggle  with  each  other  during 
several  ages,  with  balanced  success,  and  end  by  uniting  with,  or  becom- 
ing embosomed  in  the  most  powerful. 


166  ANATOMICAL   PERIOD, 


IV.  ANATOMICAL  PERIOD. 

COMPRISING  THE  PERIOD  OF  TIME  WHICH  EXTENDS  FROM  THE  FOUNDATION  OF 
THE  ALEXANDRIAN  LIBRARY,  SOME  THREE  HUNDRED  AND  TWENTY  YEARS  BE- 
FORE CHRIST,  TO  THE  DEATH  OP  GALEN,  IN  THE  YEAR  TWO  HUNDRED,  OP  THE 
CHRISTIAN  ERA. 


GENERAL     CONSIDERATIONS. 

It  was  truly  a  royal  idea,  and  worthy  of  the  successors  of  Alexander, 
that  of  collecting  together  all  the  intellectual  riches  of  the  universe, 
and  jilacing  them  at  the  disposal  of  studious  men,  who  were  desirous  to 
use  them  for  their  improvement,  and  the  advancement  of  science. 

In  order  to  conceive  all  the  grandeur  and  munificence  of  such  a  crea- 
tion, it  is  necessary  to  recall  under  what  circumstance  it  was  undertaken, 
It  should  be  remembered,  that  manuscripts  were  then  extremely  rare, 
and  consecj^uently  of  an  exorbitant  price  ;  that  of  the  greater  number  of 
works  there  were  but  veiy  few  copies,  and  often  one  only,  so  that  those 
who  possessed,  would  not  part  with  them  easily,  and  scai'cely  allow 
copies  even  to  be  made.  All  the  literary  treasure  of  a  family  consisted 
often  of  one  work  only,  and  fewer  families  yet  were  in  possession  of  such 
a  heritage.  Before  the  foundation  of  the  libraries  of  Alexandria  and 
Pergamos,  there  is  no  mention  made  of  any  considerable  collections  of 
books,  except  those  of  Pericles  and  Aristotle.  In  such  a  state  of  things, 
the  inferior  classes  of  society  were  deprived  of  all  written  instruction, 
and  a  poor  man  was  able  to  acquire,  except  under  very  extraordinary 
circumstances,  only  a  very  limited  degree  of  knowledge. 

Under  such  circumstances,  the  establishment  of  a  library,  accessible 
to  the  public,  was  an  act  of  philanthropy  and  liberality,  above  all  eulog)'. 
It  was,  at  the  same  time,  one  of  those  happy  creations  that  immortalize 
a  reign — an  epoch,  and  that  concur  to  consolidate  a  dynasty ;  for  the 
good  that  they  produce,  and  the  gratitude  they  inspire,  extend  to  the 
latest  posterity.  It  does  not  belong  to  me  to  refer  to  the  political  advan- 
tages of  which  such  an  institution  is  the  source ;  besides,  others  have 


GENEKAL  CONSIDERATIONS.  167 

acquitted  themselves  of  this  task  so  well,  as  to  leave  nothing  to  desire 
on  that  subject." 

But,  to  indicate,  in  brief,  the  influence  that  the  foundation  of  public 
libraries  must  have  exercised  upon  ancient  civilization,  it  would  be  suffi- 
cient for  me  to  say  that  it  has  been  compared,  very  justly,  to  that  which 
the  art  of  printing  has  exerted  on  modern  civilization. 

Two  of  the  lieutenants  of  Alexander  appear  to  have  conceived  the 
same  project  about  the  same  time,  so  that  it  is  now  very  difficult  to 
decide,  to  which  of  the  two  belongs  the  priority.  One  was  Eumenes, 
governor  of  Pergamos  and  Mysia ;  the  other,  Ptolomy  Lagos,  who  had 
command  of  Egypt.  At  the  death  of  the  conqueror  of  Asia,  the  generals 
that  he  placed  at  the  head  of  the  provinces  of  his  vast  empire,  shook  off 
all  dependence  on  the  central  government,  and  endeavored  to  consoli- 
date their  authority  in  every  possible  way.  The  greater  number  turned 
their  attention  entirely  to  arms,  either  to  maintain  their  own  govern- 
ment, or  to  invade  those  of  their  colleagues.  The  sovereigns  of  Alexan- 
dria and  Pergamos  were  the  only  ones,  amongst  so  many  captains,  who 
occupied  themselves  with  the  interests  of  commerce  and  arts,  and  it  was 
about  that  time,  that  they  laid  the  foundation  of  the  first  two  public 
libraries.  They  took  hold  of  the  enterprise  so  actively,  that  they,  and 
their  immediate  successors,  within  about  a  century,  had  gathered  two 
hundred  thousand  volumes  for  the  library  at  Pergamos,  and  six  to  seven 
hundred  thousand  for  that  at  Alexandria.  This  last  was  divided  into 
two  parts,  which  were  called  the  great  and  little  library.  The  first 
contained  nearly  four  hundred  thousand  volumes,  and  was  located  in 
the  quarter  named  Bruchion,  near  the  Museum  and  the  palaces,  and  in 
the  neighborhood  of  the  port,  where  the  grain  ware  houses  were  situated  ; 
the  second  was  in  the  temple  of  Serapis,  or  Serapium,  situated  in  a  dis- 
tant quarter,  nearer  the  center  of  the  city. 

It  is  not  possible,  from  the  above  enumeration,  to  form  an  exact  idea 
of  the  accumulated  riches  in  these  two  great  book  depots ;  for  writers 
differ  very  much,  when  on  the  subject  of  estimating  the  volumes,  or  rolls 
of  the  ancients,  compared  with  modern  books.  Some  presume  that  the 
six  hundred  thousand  Alexandrian  volumes  represent  two  hundred 
thousand  of  ours ;  others  one  hundred  and  twenty  thousand ;  others 
ninety  thousand.  However  it  may  be,  litei-ary  collections  of  such 
magnitude  were  a  wonderful  and  happy  result  under  the  circumstances. 
The  kings  of  Egypt,  and  those  of  Pontus,  felt  perfectly,  what  eclat  such 


^^  Notably  M.  Matter,  author  of  the  History  of  the  School  at  Alexandria,  from 
whom  we  have  borrowed  the  major  part  of  the  details  we  here  furnish  on  that 
school. 


168  ANATOMICAL   PERIOD. 

institutions  would  throw  upon  their  capitals  and  their  names.  At  first, 
their  efforts  to  collect  works,  excited  a  praiseworthy  rivalry,  but  this 
subsequently  degenerated  into  a  contemptible  jealousy,  in  some  of  their 
successors,  which  led  the  sovereigns  of  Alexandria  to  interdict  the 
exportation  of  papyrus,  so  as  to  prevent  their  emulators  of  Pergamos 
from  being  able  to  make  copies  of  manuscripts.  This  illiberal  prohibi- 
tion had  a  contrary  effect  than  was  expected,  for  it  led  to  the  invention 
of  the  paper  of  Pergamos,  otherwise  called  parchment,  the  use  of  which 
became  general,  and  displaced,  advantageously,  the  bark  of  the  papyrus. 
Nevertheless,  the  institute  of  Alexandria  always  preserved  a  great 
superiority  over  that  of  Pergamos ;  it  had  especially  a  marked  influence 
on  medical  studies,  and  merits,  on  that  account,  a  particular  notice  on 
our  part. 


CHAPTER  I. 
THE  SCHOOL  OF  ALEXANDRIA. 

The  chief  of  the  dynasty  of  the  Lagides,  Ptolomy  Soter,  was  not 
contented  with  collecting,  at  a  great  expense,  an  enormous  quantity  of 
books ;  he  felt  also  the  necessity  of  having  order  and  choice  in  his  col- 
lection. To  effect  this,  he  called  around  him  men,  the  most  renowned 
for  their  erudition,  and  gave  them  residences  near  the  library,  and  cre- 
ated a  revenue  for  their  maintenance.  Some  were  charged  with  the 
classification,  collation  and  annotation  of  the  manuscripts ;  and  the 
copies  that  underwent  this  labor  of  revisal  were  then  entered  in  the 
catalogue.  Other  savans,  equally  at  the  expense  of  the  State,  occupied 
themselves  with  the  investigations  and  studies  of  their  taste,  being  con- 
fined to  no  particular  task ;  only,  they  were  required  to  meet  together 
on  certain  days,  to  deliver  lectures  and  discuss  various  subjects.  The 
king  himself  sometimes  took  a  part  in  these  re-unions,  by  proposing  dif- 
ferent questions  for  solution,  and  taking  part  in  the  discussions. 

These  re-unions  became  still  more  frequent  and  formal  under  Ptolomy 
Philadelphus,  son  and  successor  of  Soter.  They  were  called  ludi  musa- 
rum  et  ApoUinis,  literary  contests  or  feasts,  and  the  palace  where  they 
were  held  was  named  the  Museum.  Often  the  subject  for  discussion  was 
announced  beforehand.  Those  who  succeeded  best,  received  public  eulo- 
gies and  rewards  proportionate  to  the  merit  of  their  compositions.  All 
the  savans,  artists  and  professors,  that  lived  in  Alexandria,  were  not 
lodged  in  the  Museum,  nor  pensioners  of  the  king ;  that  honor,  and  the 
privileges  which  were  attached  to  it,  were  accorded  to  a  very  small  num- 
ber.    Amongst  those  who  enjoyed  it,  under  the  reign  of  the  first  two 


SCHOOL   OF   ALEXANDRIA.  169 

Lagides,  only  two  physicians  are  named,  viz :  Herophilus  and  Erisistra- 
tus.  The  latter,  it  is  said,  was  the  grandson  of  Aristotle,  and  pupil  of 
Theophrastus.  He  did  not  reside  in  the  capital  of  Egypt  till  the  close 
of  his  life ;  for  it  appears  that,  in  his  old  age,  he  retired  to  Smyrna, 
where  he  founded  a  school. 

It  was  under  Philadelphus  that  the  Hebrew  savans  were  charged  with 
the  translation  into  Greek,  of  the  Holy  Scriptures  ;  and  it  is  well  known 
that  the  translation  they  made,  called  the  Septuagint,  has  always  been 
highly  esteemed.  An  Egyptian  priest  always  presided  over  the  museum, 
so  that  the  Alexandrian  Institute  included  the  debris  of  the  antique  sci- 
ence of  Egypt,  the  doctrines  of  the  Jews,  and  the  more  recent  compo- 
sitions of  the  philosophers  and  literati  of  Greece.  Besides,  the  sover- 
eigns of  Egypt  sent  more  than  one  expedition  into  the  interior  of  Africa, 
along  the  coasts  of  the  Eed  Sea,  and  as  far  as  the  East  Indies,  to  make 
discoveries  and  establish  relations  in  the  interests  of  commerce  and  the 
sciences.  Thus  the  torch  of  civilization,  which  had  anciently  shone 
upon  the  banks  of  the  Nile  with  a  mysterious  and  isolated  light. 
returned,  after  being  increased  and  vivified  at  the  free  fires  of  the  geniug 
of  Greece,  to  shed  an  eclat  more  resplendent  than  ever  on  its  early 
cradle ;  and  thus  the  city  of  the  Ptolomies  became  not  only  the  entre- 
pot of  Greek  and  Eoman  commerce,  but  also  a  scientific  focus,  whose 
light  was  shed  for  ten  centuries  upon  the  antique  universe. 

Amongst  the  sciences  which  received  the  most  encouragement  in  the 
Institute  of  the  Lagides,  we  must  place  in  the  first  rank  that  of  Medi- 
cine. By  a  concourse  of  happy  circumstances  which  we  shall  presently 
enumerate,  the  school  of  Alexandria  eclipsed,  from  its  origin,  the  ancient 
schools  of  Cridas,  Cos,  and  Pergamos ;  and  while  it  existed,  it  was  not 
equaled  by  any  other.  In  the  time  of  Galen,  it  sufiiced  to  have  studied 
in  that  city,  or  even  to  have  resided  there  for  a  time,  to  obtain  the  repu- 
tation of  a  physician.  Nearly  all  the  men  who  became  distinguished 
in  the  different  branches  of  the  healing  art,  for  a  considerable  length  of 
time,  had  received  instruction  in  that  school,  or  had  been  there,  to  per- 
fect their  knowledge  in  their  profession. 

The  success  in  the  cultivation  of  Medicine  in  the  Greco-Egyptian 
Institute,  was  due,  as  we  have  said,  to  several  causes,  at  the  head  of 
which  we  must  place  the  authorization  accorded  by  the  founders  of  that 
establishment,  for  the  dissection  of  human  corpses.  Doubtless  that 
authorization,  nearly  unique  in  antiquity,  gave  to  the  anatomical,  physio- 
logical and  surgical  sciences  an  extraordinary  impulse.  But  the  princes 
of  the  family  of  the  Lagidce  did  not  content  themselves  with  delivering 
over  to  the  scalpel  of  the  anatomists  the  corpses  of  criminals ;  they  par- 
ticipated themselves  sometimes,  it  is  said,  in  the  labors  of  dissection  :. 
11 


170  ANATOMICAL  PERIOD. 

so  anxious  were  they  to  penetrate  the  secrets  of  nature  and  life.  Per- 
haps, also,  they  did  so  to  destroy,  by  the  force  of  their  example,  the 
odium  to  which  the  physicians  exposed  themselves  by  their  anatomical 
researches.'-' 

The  rtolomies  did  not  favor  less  the  progress  of  natural  history  and 
the  materia  medica,  by  the  collection  of  rare  animals  and  plants  that 
were  made  for  the  museum,  near  their  palace.  They  spared,  if  we  may 
believe  the  tradition  respecting  it,  neither  expense  nor  care  to  render 
these  collections  as  complete  as  possible ;  they  were  proud  to  exhibit 
them  to  the  savans  and  travelers  of  distinction  whom  the  renown  of  their 
intellectual  riches  attracted  to  their  capital ;  a  policy  both  eminent  and 
liberal,  and  which,  even  after  the  destruction  of  the  kingdoms  of  Egypt, 
maintained  the  city  of  Alexandria  in  the  rank  of  the  first  cities  of  the 
empire. 

Nevertheless,  the  practice  of  dissections  did  not  long  continue  in  favor, 
even  in  the  city  where  it  had  its  origin ;  scarcely  did  it  continue  to 
exist  to  the  end  of  the  second  century.  Consequently,  science  very  soon 
took  a  bad  direction  at  Alexandria ;  natural  researches  were  replaced  by 
subtile  discussions  on  subjects  idle  or  inaccessible  to  the  human  under- 
standing. But  of  all  the  scourges  which  hindered  the  progress  of 
medical  science  in  Egypt,  that  of  the  Roman  domination  was  the  most 
fatal.  That  royal  people,  who  delighted  to  see  blood  flow,  not  only  on 
the  battle-field,  but  also  in  their  diversions  and  daily  exhibitions, 
regarded  as  a  profanation  the  contact  of  a  corpse ;  so  that  not  a  single 
anatomist  of  any  reputation  had  his  origin  in  Eome.  If,  on  any  occa- 
sion a  foreign  physician,  attached  to  the  persons  of  the  Emperors  or 
Generals,  desired  to  avail  himself  of  the  occasions  that  were  afforded,  to 
examine  the  structures  of  the  internal  parts  of  the  human  body,  he  was 
obliged  to  conceal  and  carry  off,  during  the  night,  some  body  abandoned 
to  the  birds  of  prey. 

To  complete  our  misfortune,  the  labors  of  the  physicians  who  illus- 
trated the  first  epoch  of  the  school  of  Alexandria,  are  all  lost ;  we  only 
know  of  them  now  by  tradition,  and  by  fragments  that  writers  of  a  later 
period  have  preserved.  The  burning  of  the  great  library,  by  Julius 
Caesar,  was  the  beginning  of  a  chain  of  disasters  with  which  the  Roman 
domination  cursed  the  Alexandrian  Institute.  However,  Queen  Cleo- 
patra, whose  enlightened  zeal  for  the  sciences  has  rendered  her  quite  as 
celebrated  as  her  beauty,  her  frailties,  her  crimes,  and  her  death — Cleo- 
patra, I  say,  repaired  as  much  as  possible  this  loss,  by  obtaining  from 


'*  Pliny,  Natural  History.  T.  XIX.,  p.  5.     Lanth.  Hist,  de  I'Anatomie,  Stras- 
bourg, lb45. 


ANATOMY  AND   PHYSIOLOGY.  171 

her  spouse,  Mark  Antony,  the  transportation  of  the  library  of  Perga- 
mos  to  Alexandria.  But  a  more  grievous  and  irreparable  Mow  was  given 
to  this  establishment,  by  the  atrocious  and  imbecile  Cavacalla,  who, 
after  having  assassinated  the  greater  part  of  the  inhabitants  of  the  city, 
took  from  the  pensioners  of  the  Museum  the  privilege  of  living  together, 
and  the  other  advantages  which  they  enjoyed,  and  suppressed  the  public 
exhibitions  and  discussions/-- 

We  can  now  only  trace  the  progress  of  science  through  that  period, 
by  collecting  and  comparing  the  debris  which  have  been  preserved  by 
Galen,  Aretgeus,  Coelius,  Aurelianus,  Celsus,  Dioscorides,  Pliny,  and 
some  others.  It  is  by  the  aid  of  these  scattered  documents  that  we 
proceed  to  reconstruct  the  scientific  edifice  of  Medicine,  as  it  existed  at 
the  end  of  the  second  century  of  the  Christian  era.  In  attempting  this, 
we  shall  follow  the  same  order  that  we  have  already  adopted,  namely, 
commence  by  showing  the  material  progress  of  each  branch  of  the  art. 
and  reserve  for  the  end  the  discussion  of  the  themes  and  systems  of 
the  time. 


CHAPTEE    II. 
ANATOMY  AND  PHYSIOLOGY. 

"We  have  seen,  that  after  bringing  together  all  the  fragments  the 
Hippocratic  writers  have  transmitted  to  us,  relative  to  the  structure  of 
the  human  body,  it  would  be  impossible  to  compose  from  them  a  regular 
or  complete  treatise  on  anatomy  ;  for,  with  the  exception  of  the  skeleton, 
they  possessed  very  limited  and  imperfect  notions  of  any  organic  appa- 
ratus. They  confounded,  under  a  common  name,  the  nerves,  ligaments, 
and  tendons  ;  they  did  not  distinguish,  or  very  imperfectly,  the  arteries 
and  veins,  and  the  muscles,  in  their  eyes,  were  inert  masses,  designed 
solely  to  cover  the  bones,  and  serve  as  an  envelope  or  an  ornament. 
They  possessed,  in  short,  only  gross  and  false  ideas,  on  the  structure 
and  functions  of  the  brain,  heart,  liver,  lungs,  digestive  and  generative 
apparatus  —  for  the  reason  that  they  had  never  been  able,  as  well 
remarks  the  author  of  the  History  of  Anatomy,  to  devote  themselves  to 
regular  dissections  ;  but  this  did  not  prevent  them  from  adducing  very 
decisive  opinions  on  the  organs  and  their  functions,  which  no  one  could 
either  verify  or  deny. 

Let  us  now  see  what  additions  and  what  improvements  the  physicians 
of  the  following  period  conferred  upon  that  state  of  the  science.     Galen 

"Hist,  de  I'Anatomie,  p.  117. 


172  ANATOMICAL   PERIOD. 

is  the  sole  author  of  that  period,  whose  writings  on  anatomy  and  physi- 
ology have  not  entirely  perished.  We  have  several  works  of  his  on 
these  subjects,  which  treat  especially  on  these  two  branches,  viz  :  First, 
a  monograph  on  the  Skeleton,  in  which  he  recommends  that  the  bones  be 
not  studied  in  books  only,  but  that  they  be  seen  and  handled  ;  and  to 
do  that,  he  advises  the  student  to  go  to  Alexandria,  where  the  pro- 
fessors, he  says,  will  place  before  him  the  human  skeleton.  This  advice 
of  Galen  proves,  that  in  his  time  there  was  not  in  Rome  a  single  skeleton. 
on  which  to  demonstrate  osteology.  Secondly,  a  complete  treatise  on  Ana- 
tomy, divided  into  fifteen  books,  of  which  six  are  wanting,  entitled,  On  Ana- 
tomical xldministration.  Thirdly,  an  anatomo-physiological  treatise  on 
the  Functions  of  the  Eegions  of  the  human  body — distributed  in  seventeen 
books,  which  we  have  entire.  And  finally,  a  quantity  of  anatomical  and 
physiological  details,  scattered  in  various  writings,  which  relate  to  other 
subjects.  It  is,  then,  from  the  writings  of  Galen,  chiefly,  that  we  draw 
what  we  have  to  say  on  the  progress  of  anatomy  and  physiology,  in  the 
period  extending  from  the  foundation  of  the  Alexandrian  library,  to  the 
end  of  the  second  century  of  the  Christian  era. 

SKELETONOLOGY. 

We  have  said  that  the  osseous  system  was,  of  all  the  organic  appara- 
tus, the  one  best  understood  by  the  Asclepiadze  ;  nevertheless,  their 
successors  added  many  details  to  the  descriptions  they  had  given  of  it. 
They  studied  especially,  with  more  care,  the  formation  of  bones,  their 
internal  structure,  and  mode  of  union.  Galen  says,  that  the  bones  are 
hard,  cold,  dry  bodies,  of  an  earthy  nature,  possessing  no  sensibility, 
because  they  are  destitute  of  nerves,  but  able  to  realize  pain  through 
the  membrane  covering  them,  which  is  named  the  periostium.  They 
served  to  sustain  the  whole  mass  of  the  body,  and  are  formed  directly 
from  the  semen  ;  the  greater  number  have  a  marrow,  from  which  they 
obtain  nourishment.  Their  various  modes  of  union,  he  reduced  to  two, 
namely,  symphysis  and  articulation.  By  symphysis,  two  bones  arc 
joined  or  glued  strongly  together,  so  that  they  can  not  move  on  each 
other.  By  articulation,  on  the  contrary,  they  are  placed  in  juxtaposi- 
tion, and  move  more  or  less  freely  on  each  other.  The  ligaments  main- 
tain and  fix  the  articulations  ;  they  are  white  structures,  flexible,  and 
elastic,  harder  and  thicker  than  membranes.  The  cartilages,  which 
terminate  certain  bones,  or  even  take  their  place  in  certain  structures, 
such  as  the  nose,  ears,  and  wind-pipe,  have  almost  the  hardness  of  bones, 
with  the  flexibility  and  elasticity  of  ligaments.-'     The  author  of  the 

-Galen,  De  Ossibus,  edition  of  Chartier,  T.  IV.  De  Anatomicis  Administra- 
tionibus,  lib.  i,  T.  IV. 


ANATOMY  AND   PHYSIOLOGY.  173 

History  of  Anatomy  says,  that  Galen  was  profoundly  versed  in  the 
knowledge  of  the  bones ;  that  he  described  them  nearly  all,  individually, 
and  that  there  are  few  of  them,  which  are  not  mentioned  by  name  in 
his  works. 

MYOLOGY. 

The  muscles  (chairs)  were  no  longer  considered  as  inert  masses, 
serving  only  to  cover  the  bones,  and  protect  other  parts ;  they  were 
divided  into  distinct  fasciculi,  and  named  muscles.  The  form,  compo- 
sition, and  uses  of  each  muscular  faciculus,  was  studied  separately,  and 
they  were  recognised  as  constructed  of  minute  fibres,  or  filaments, 
between  which  the  veins,  arteries,  and  nerves  ramified,  carrying  nutri- 
tion, life,  and  sensation.  It  was  proved  by  convincing  experiments,  that 
the  muscles  are  indispensable  to  the  accomplishment  of  voluntary  move- 
ments. Galen,  being  desirous  to  teach  the  mechanism  of  locomotion, 
and  to  prove  that  the  muscles  take  an  active  part  in  it,  was  accustomed 
to  expose  on  an  animal,  the  extensor  and  flexor  muscles  of  a  member, 
and  then  demonstrate  how  the  alternate  tension  and  relaxation  of  the 
muscular  fasciculi  set  the  bones  in  motion,  after  the  manner  of  levers. 

He  says  that  the  muscles  are  so  numerous,  that  they  cannot  be  easily 
counted,  and  unite  in  such  a  manner,  that  several  seem  to  form  but  one, 
and  when  they  divide,  there  appears  to  be  as  many  as  there  are  tendons. 
It  is  not  wonderful,  after  this  avowal,  that  he  omitted  several ;  never- 
theless, he  pointed  out,  and  named  a  great  number.  He  classed  them 
according  to  their  uses,  and  this  method,  which  has  been  followed  even 
till  our  day,  by  many  anatomists,  is  the  most  advantageous  with  which 
to  arrive  at  the  knowledge  of  the  movements  executed  by  the  parts, 
though  it  may  not  be  the  most  commodious  to  guide  us  in  an  anatomical 
examination.'-' 

ANGIOLOGY. 

The  Hippocratic  authors  confounded  the  arteries  with  the  veins. 

Praxagoras  was  the  first  who  distinguished  these  two  orders  of  vessels, 
but  he  supposed  that  the  arteries  contained  air,  and  not  blood.  He 
therefore  gave  them  the  name  they  still  bear,  which  signifies,  according 
to  their  etymology,  aerian  canal.  Aristotle  and  Erisistratus,  having 
adopted  this  view,  it  prevailed  until  the  time  of  Galen,  for  this  author 
devoted  an  entire  book  to  refute  it,  sustaining  himself  upon  the  observa- 
tion, that  at  all  times,  when  an  artery  is  wounded,  the  blood  gushes  out. 

"  Galen,  De  Constitutione  artis  medic,  cap.  in.,  Chartier,  T.  II,  De  Anatomicis  ad- 
ministration ibus,  lib.  i.,iL,  iiL,  IV.,  V.  De  usu  partium  corporis  humaui,  lib.  iii., 
cap.  V. 


174  ANATOMICAL  PERIOD. 

He  added  to  this  experimental  proof,  many  theoretical  reasons,  which, 
doubtless,  he  supposed  appropriate  to  fortify  it,  but  which  now  appear 
very  obscure  and  useless/"^ 

He  placed  the  origin  of  the  veins  in  the  liver,  which  he  regarded  as 
the  organ  of  sanguification,  by  which  he  shows  himself  less  advanced 
than  Aristotle,  who  considered  the  heart  as  the  common  source  of  the 
arteries  and  veins.  He  compares  the  arterial  and  venous  system  to  a 
tree  fixed  by  its  roots  in  the  soil,  from  which  the  trunk  arises,  and  is 
developed  by  ramifications.  The  divisions  of  the  vena  portse  form  the 
roots  of  the  venous  tree,  the  vena  cava  its  trunk,  whence  proceeded  the 
boughs  and  twigs,  distributed  to  every  part.  So,  also,  in  the  arterial 
system,  the  pulmonary  artery  constitutes  the  roots,  the  aorta  the  trunk, 
which  is  ramified  like  branches  and  twigs,  to  all  parts  of  the  body. 
Among  the  branches  of  the  vena  cava  superior,  he  reckons  the  vena 
azygos,  the  internal,  mammary,  etc.,  etc.,  and  among  those  of  the  vena 
cava  inferior,  he  describes  the  renal,  spermatic,  uterine,  and  other  veins 
of  the  inferior  extremities.  In  the  table  of  the  arterial  system,  he 
erroneously  distinguishes  a  superior  and  inferior  aorta.  The  history  of 
the  ramifications  of  the  superior  aorta  is  a  little  confused,  but  the 
description  of  aorta  inferior  is  more  exact.  Our  author  makes  mention 
of  umbilical  veins  and  arteries.  He  is  also  not  ignorant  that  the  veins 
are  more  numerous  than  the  arteries ;  for  while  the  latter,  he  says,  are 
always  accompanied  by  veins,  the  veins  are  often  found  separately  from 
arteries,  f 

NEUROLOGY, 

G-alen  states  that  all  the  nerves  are  derived  from  the  brain  and  spinal 
marrow,  which  was  contrary  to  the  views  of  Aristotle,  who  supposed 
them  to  originate  at  the  heart ;  but  the  physician  of  Pergamos  proves 
that  he,  as  well  as  those  who  followed  him,  confounded  the  nerves  with 
the  ligaments  and  tendons.  He  points  out  also  two  sorts  of  nerves,  one 
of  which,  those  of  sensation,  are  soft,  and  proceed  from  the  brain  ;  the 
nerves  of  motion,  are  harder,  and  originate  in  the  spinal  marrow.  He 
enumerates  seven  pairs  of  cerebral  nerves,  which  comprises  all  that  are 
admitted  now,  except  the  sympathetic,  and  the  external  motor  of  the 
orbit ;  thirty  pairs  of  spinal  nerves,  which  he  divides  as  follows :  eight 
cervical,  twelve  dorsal,  five  lumbar,  and  five  sacral.  "  Thus,"  observes 
M.  Daremberg,  "  Galen  describes  distinct  nerves  of  sensation  and  motion  ; 
but  he  did  not  know  that  each  nerve,  by  its  double  origin  on  the  anterior 

'  Galen.     An  in  Arteriis  natura  sanguis  continmtur.     Chartien,  Tome  Til. 
■flbid.,  De  Venarum  et  Arteriaram  discestione,  T.  VI.     De  usu  partium,   Jh.  Lanth 
Hist,  d  I'Anatoniie,  liv.  v.,  part  i.,  sect,  i.,  chap,  in.,  §  4. 


ANATOMY  AND   PHYSIOLOGY.  175 

and  posterior  parts  of  the  spinal  marrow,  contained  both  sensory  and 
motor  filaments."  The  ganglions  of  the  nervous  system,  were  well 
known  to  him,  and  he  claims  their  discovery.  "  Nature,"  he  says,  "  has 
done  an  admirable  thing,  of  which  all  anatomists,  to  the  present  time, 
were  ignorant.  When  she  conducts,  for  a  long  distance,  a  fine  nerve,  or 
one  is  destined  to  excite  violent  muscular  movements,  she  locates  a  little 
mass  on  its  track,  that  resembles  it  in  structure.  Seen  externally,  this 
body  appears  to  rest  upon,  and  surround  the  nerve  ;  but  when  it  is  dis- 
sected, its  substance  is  found  to  be  in  continuity  with  the  nerve  com- 
bining with  its  structure,  and  resembling  it  in  every  particular.  It  is 
by  means  of  this  substance,  which  resembles  a  ganglion,  that  nerves 
augment  in  size.--' 

Lastly,  this  eminent  anatomist  had  some  notions  of  the  great  sympa- 
thetic, though  he  may  not  have  formed  a  complete  idea  of  that  nerve. 

To  prove  that  the  faculties  of  motion  and  sensation  were  transmitted 
from  the  encephalor  to  other  parts  of  the  body,  by  the  nervous  apparatus, 
he  advised  that  the  principal  nerve  of  any  member  be  divided ;  at  once, 
he  remarks,  the  parts  situated  below  the  section,  loose  their  faculties  of 
sensation  and  motion,  while  those  above  retain  both.f 

ADEXOLOGY. 

"  Galen,"  says  the  author  of  the  History  of  Anatomy,  before  quoted, 
"  gives  no  anatomical  description  of  the  glands,  though  he  may  have 
been  acquainted  with  the  fluids  secreted  by  several  of  these  organs. 
After  enlarging  on  the  secretion  of  the  prostrate  gland,  he  passes  to  the 
mucus  and  saliva  contained  in  the  mouth,  to  the  bile  secreted  by  the 
liver,  and  to  the  humors  furnished  to  the  intestines  by  various  glands. 
Sustaining  the  opinion  of  Marinus,  on  the  functions  of  glands,  he  says 
that  the  salivary  glands  transmit  the  saliva  into  the  mouth  by  particular 
veins.  He  terms  the  mammae  also,  glandular  bodies.  Is  it  not,  then, 
strange,  that  with  the  knowledge  this  great  man  possessed  of  the  fluids 
furnished  by  the  various  glands,  the  idea  was  never  suggested  to  him. 
to  attribute  to  those  bodies,  the  special  function  of  preparing  a  useful 
fluid,  instead  of  regarding  them  as  receptacles  of  an  excremantitial 
humor  of  the  emunctory  vessels  ?  That  happy  idea  never  occurred  to 
him ;  the  preparation  of  a  fluid  was  always,  in  his  eyes,  a  very  secondary' 
afi"air  in  the  functions  of  glands ;  the  supposition  of  veins  which  carried 


"  Galen,  De  urn  partium.    Lanth.  Hist,  d  I'Auat.,  liv.  v.,  part  i. ,  sect,  i.,  cliap.  ui. 
§5. 
f  De  Constitutione  artis.,  cap.  in. 


176  ANATOMICAL  PERIOD. 

the  saliva  into  the  mouth,  was  only  imaginary,  for  his  idea  of  them  has 
no  agreement  at  all  with  the  salivary  duct,  now  called  the  duct  of  Steno.'-* 

SPLANCHNOLOGY. 

Galen  divided  the  interior  of  the  body  into  three  cavities ;  namely, 
the  abdominal,  thoracic,  and  cranial,  of  which  last,  the  vertebral  canal 
is  an  extension.  He  distinguishes  in  each  of  these,  the  viscera  from  their 
envelopes  ;  of  the  latter,  which  are  common  to  all,  he  reckons  the  skin, 
composed  of  two  lamina,  the  dermis  and  epidermis  ;  the  fat ;  the  muscles 
with  their  aponuroses,  vessels  and  nerves ;  the  bones ;  and  some  mem- 
branes. The  viscera  being  different  in  each  cavity,  require  to  be  enu- 
merated separately. 

I.    ABDOMINAL  CAVITY. 

It  includes  the  apparatus  of  the  natural  faculties,  which  he  divides 
into  the  organs  of  nutrition  and  reproduction.  The  nutritive  organs 
are  of  three  kinds.  The  first  receive  the  food,  dispose  of,  and  distri- 
bute it  to  all  parts  ;  they  are  the  mouth,  esophagus,  stomach,  intestines, 
and  veins  of  the  liver.  The  second,  which  appear  destined  to  eliminate 
excrementitial  particles,  are  the  liver,  which  attracts  the  bile,  the  spleen, 
the  kidneys,  and  their  appendages.  Lastly,  the  third  class,  which  serves 
for  the  expulsion  of  fecal  matter,  and  which,  in  order  to  be  controlled 
by  the  will,  is  furnished  with  muscles.  Galen  describes  in  detail  the 
form,  situation,  and  structure  of  each  of  these  organs.  (See  especially 
the  Anatomical  Administrations  and  the  treatise  on  the  Functions  of  the 
Organs ;  see  also  the  Hist,  de  I'Anatomie,  already  cited.) 

The  reproductive  apparatus  is  composed  in  man  of  testicles,  placed 
out  of  the  body,  in  the  scrotum,  sanguineous  vessels,  and  nerves ;  the 
epididymus,  a  small  body  placed  on  the  upper  part  of  the  testicles  ;  the 
spermatic  canal,  or  vas  deferens ;  the  vesiculte  seminalae  ;  the  prostrate 
gland  ;  and  the  penis,  which  is  a  nervous  and  hollow  body,  springing 
from  the  ossa  pubis,  but  containing  no  humor.  In  women,  whose  nature 
■is  colder  than  that  of  man,  the  sexual  parts  are  placed  in  the  interior 
of  the  body.  The  testicles,  which  are  smaller,  are  situated  on  the  sides 
of  the  uterus,  and  within  the  abdomen.  The  spermatic  ducts  (uterine 
tubes)  unite  the  testicles  to  the  uterus,  which  is  placed  between  the 
bladder  and  the  rectum.  Galen  speaks  of  two  uterine  cavities,  one  on 
the  right,  destined  for  the  male  fetus,  the  other  on  the  left,  for  the  female. 
From  this  statement  we  may  question  whether  he  ever  examined  the 
uterus  of  a  woman.  The  presumption  is,  that  he  had  studied  this  organ 
in  animals  only,  for  he  says,  that  the  number  of  the  departments  in  the 

"Lanthion,  Hist,  de  I'Anat. 


ANATOMY  AND   PHYSIOLOGY.  177 

uterus  is  equal  to  the  number  of  mammae.  The  bottom  of  the  uterus 
is  turned  toward  the  stomach ;  its  neck  looks  downward,  and  is  con- 
tinuous with  the  vagina,  which  is  a  membranous  canal,  terminating 
externally  at  the  vulva.  In  coition  the  semen  of  the  male,  which  is 
hotter  than  that  of  the  female,  mingles  with  the  latter,  which  serves  as 
an  excipient  and  nutritive  material ;  from  this  results  fecundation.  The 
semen  changes  at  first  into  membranes,  then  a  portion  of  these  are  trans- 
formed into  cartilages  and  bones  ;  another  portion  is  folded  and  hollowed, 
and  extends  itself  in  the  form  of  pipes,  which  constitute  the  arteries 
and  veins ;  another  is  drawn  out  like  fine  threads,  whence  proceed  the 
fibers  and  nerves,  and  so  on,  for  the  rest  of  the  tissues.'-'^ 

II.    THE   THORACIC   CAVITY. 

It  is  separated  from  the  abdomen  by  the  diaphragm,  a  species  of 
round  muscle,  large,  flat,  and  thin,  having  its  tendons  in  the  middle. 
It  includes,  among  other  things,  the  heart  and  lungs,  organs  of  the 
vital  faculty.  The  heart,  situated  in  the  middle  of  the  breast,  a  little 
to  the  left  side,  lies  upon  the  lungs,  as  on  a  downy  bed.  It  has  the 
appearance  of  a  muscle,  but  difi"ers  from  one  in  many  respects.  In  the 
first  place,  its  substance  is  much  harder,  and  more  resisting  than  mus- 
cular flesh  ;  in  the  second  place,  it  is  formed  of  straight,  transverse,  and 
oblique  fibers  ;  in  a  word,  the  fibers  run  in  all  directions,  which  is  not 
the  case  in  ordinary  muscles.  Lastly,  the  heart  possesses  its  own  pro- 
per movements,  which  do  not  depend  upon  nervous  agency,  as  may  be 
seen  by  opening  the  chest  of  a  living  animal ;  for  when  the  heart  is 
separated  from  all  other  parts,  it  continues  its  movements  for  some  time 
with  much  force.  This  organ  is  the  source  of  natural  heat,  and  the 
vital  spirits  ;  the  seat  of  anger,  and  violent  passions.  His  opinions  on 
the  movement  of  the  blood,  will  be  alluded  to  hereafter. 

The  lungs,  a  spongy  viscus,  which  nearly  fills  the  whole  cavity,  is 
divided  in  its  length  into  two  unequal  cavities  ;  the  right  half,  which  is 
the  largest  is  separated  into  three  lobes  ;  the  left  one  into  two.  These 
lobes  all  comunicate,  by  means  of  cartilagino-membranous  tubes,  with 
a  common  tube,  which  is  called  the  trachea-arteria.  This  proceeds 
upwards,  along  the  median  line,  in  front  of  the  esophagus,  to  the  back 
of  the  mouth,  where  it  terminates  by  an  orifice  called  the  larynx.  He 
divides  the  acts  of  respiration  into  two  periods  ;  in  the  first,  which  he 
names  inspiration,  the  thoracic  cavity  is  enlarged,  and  the  external  air 
is  drawn  through  the  trachea  into  the  lungs.  During  the  second  period, 
which  is  that  of  expiration,  the  impure  and  gi-osser  part  of  the  air 

*  Galen,  De  usu  partium.     De  semine,  et  alibi. 


178  ANATOMICAL  PERIOD. 

contained  in  the  chest  are  expelled  outwards,  with  the  fuliginosities  of 
the  heart,  while  the  more  subtle  part  passes  into  the  venous  artery,  to 
be  carried  to  the  left  cavities  of  the  heart,  where  it  aids  in  the  support 
of  the  natural  heat,  the  formation  of  vital  spirits,  and  the  completion  of 
the  arterial  blood. '••= 

III.   CEEEBRO- SPINAL  CAVITY. 

This  differs  from  the  two  preceding ;  first,  in  that  it  is  shut  in  on  all 
sides  by  bones ;  secondly,  in  place  of  being  lined  interiorly  by  a  single 
membrane,  like  the  thorax  and  abdomen,  there  are  two — one  thick,  hard 
and  fibrous,  the  other  thin  and  smooth,  precisely  like  the  peritoreum,  or 
pleura.  This  cavity  encloses  the  organs  of  the  noblest  of  the  faculties, 
the  animal  faculty,  of  which  the  essence  is  nothing  less  than  the  reason- 
ing and  immortal  soul. 

In  the  upper  and  anterior  part  of  the  cavity  is  found  the  brain,  an 
oval,  but  not  very  consistent  mass,  of  a  gray  color  on  the  surface,  but 
white  otherwise,  and  divided  into  two  halves  or  hemispheres,  by  a  very 
deep  longitudinal  furrow.  Beneath  it,  and  behind,  is  the  cerebellum  or 
smaller  brain,  whose  substance  appears  to  be  firmer,  though  its  volume 
scarcely  equals  the  fourth  of  the  brain.  These  two  fill  the  cranial 
cavity,  but  they  are  distinct  and  separated  in  nearly  their  whole  extent 
by  membranes ;  they  have  a  common  bond  of  union,  which  is  called  the 
meso-cephelon,  which  is  situated  at  the  base  of  the  cranium.  At  this 
point  the  spinal  marrow  commences,  which  descends  the  whole  length  of 
the  spinal  canal.  Its  substance  is  analogous  to  that  of  the  cerebrum  and 
cerebellum,  and  is  a  prolongation  of  the  latter.  Galen  describes  sepa- 
rately each  of  the  three  portions  of  these  viscera.  He  describes  their 
exterior  form  and  connections  with  neighboring  parts :  then,  peneti*ating 
into  their  interior  by  methodic  sections,  he  studies  their  intimate  struc- 
ture, the  disposition  of  their  smallest  parts,  the  origin  and  distribution 
of  their  vessels,  etc.  He  follows  each  nerve  into  the  structure  of  the 
brain,  until  it  is  lost  in  the  mass. 

When  the  brain  of  a  living  animal  is  uncovered,  by  removing  a  por- 
tion of  the  vault  of  the  cranium,  that  viscus  is  seen  rising  and  falling, 
alternately.  This  phenomenon  did  not  escape  Galen,  who  compared  it  to 
the  pulmonary  respiration,  and  attributes  it  to  the  same  cause.  He 
thinks  that  the  brain  expands  like  the  lungs,  to  draw  in  the  air,  and 
then  contracts  to  expel  it.  According  to  him,  the  atmospheric  fluid 
penetrates  the  cavity  of  the  cranium,  through  the  cribi-form  plate  of 
the  ethmoid  bone,  and  passes  out  by  the  same  route,  carrying  with  it 

*•'  Galen,  De  Usu  Partium.     De  Anatomcis  Administrationibus. 


\ 


SCHOOL   OF  ALEXANDRIA.  179 

the  excrementitial  humors  of  the  brain,  which  run  into  the  nasal  fossae. 
Xevertheless,  says  this  physiologist,  the  air  introduced  into  the  cephalic 
cavity,  by  inspiration,  is  not  entirely  rejected  by  expiration.  A  portion 
insinuates  itself  into  the  anterior  ventricles  of  the  brain,  and  unites  with 
the  vital  spirits,  which  are  carried  there  by  the  arterioles  of  the  choroid 
plexcus,  From  this  combination  originate  the  animal  spirits,  the  imme- 
diate agents  of  the  rational  soul,  and  the  most  subtle  of  all  the  spirits. 
These  acquire  their  last  attenuation  in  the  fourth  ventricle,  where  they 
are  instilled,  if  one  may  say  it,  drop  by  drop,  through  a  round,  narrow, 
vermiform  tube  (the  acqueduct  of  Sylvius) .  Then  the  animal  spirits  are 
transfused  into  the  substance,  even,  of  the  brain,  little  brain,  and  spinal 
marrow,  where  they  are  kept  in  reserve,  to  be  distributed  by  the  agency 
of  the  nerves  to  all  parts  of  the  body ;  and  they  give  to  each  region, 
according  to  the  direction  and  wants  of  the  animal  faculty,  sensation, 
motion,  and  energy." 

The  above  sketch  of  the  anatomy  and  physiology  of  Galen,  though 
very  brief,  represents  to  us  the  state  of  these  two  branches  of  medical 
science,  at  the  end  of  the  second  century  of  the  Christian  era,  and  gives 
us  an  idea  of  the  progress  that  was  made  during  the  Anatomical  Period. 
This  progi'ess  was  immense ;  and  when  we  consider  that  the  greater  part 
of  it  was  effected  in  the  first  two  centuries  of  the  foundation  of  the 
Alexandrian  school,  and  that  it  was  due  chiefly  to  the  labors  of  Hero- 
philus  and  Erisistratus,  we  are  astonished  at  the  rapid  development,  as 
well  as  the  happy  direction,  that  these  two  great  men  gave  to  anatoraico- 
physiological  studies.  Not  only  did  they  devote  themselve  to  numerous 
dissections  of  the  human  body,  but  they  often  resorted  to  vivisections 
of  animals  also.  The  chronicle  says  that  one  of  them,  Herophilus,  did 
not  hesitate  to  employ  his  scalpel  on  living  criminals  that  were  subjected 
to  his  experiment,  for  the  interests  of  science ;  but  it  is  proper  to  say 
that  this  is  not  alluded  to  by  any  cotemporary  author — it  was  only 
recorded  as  a  popular  tradition,  three  or  four  centuries  later  ;■]■  so  that 
it  is  considered  doubtful  by  many  historians,  who  remarked,  besides, 
very  correctly,  that  the  same  report  has  been  falsely  circulated  at  differ- 
ent epochs,  against  other  celebrated  anatomists.  However  this  may  be, 
the  manners,  too  often  unpitying,  of  the  ancients — the  contempt  which 
they  generally  expressed  for  the  sufferings  of  criminals  and  slaves,  per- 
mit us  to  believe  that,  occasionally,  men  may  have  been  found  so  lost 
to  the  sentiments  of  humanity,  as  to  deliver  to  the  knife  of  the  anatomist 
the  unfortunate  condemned,  in  the  hope  of  discovering,  in  the  depths  of 

*  Galen,  De  Anatomicis  Administrationibus.    De  Usu  Partium. 

f  Celse,  Traite  de  la  Me'decine,  Pre'face. — Tertullien,  De  I'Ame,  chap.  x. 


180  ANATOMICAL  PERIOD.  ^ 

the  palpitating  entrails,  the  secret  of  life  and  the  means  of  prolonging 
it ;  nor  is  it  more  improbable  that  some  fanatic  in  science  may  have  lent 
himself  to  this  odious  research ;  for,  alas !  all  fanaticism  is  pitiless. 

Nevertheless,  as  before  remarked,  the  zeal  for  dissections  rapidly 
cooled  off,  as  Galen  barely  mentions  five  or  six  men  who  devoted  them- 
selves to  it,  from  the  first  anatomists  of  Alexandria  down  to  his  own 
time — i.  e.,  through  the  space  of  nearly  four  hundred  years.  He  cites 
a  Eufus  of  Ephesus,  who  lived  probably  under  Trajan;  a  Marinus,  who 
wrote  in  the  beginning  of  the  second  century  of  the  Christian  era ;  a 
Quintus,  who  did  not  compose  any  work  on  anatomy,  but  who  instructed 
several  pupils,  among  whom  are  counted  Pelops  and  Satyrus,  who  were 
the  preceptors  of  Galen.  None  of  these  anatomists  have  left  a  reputa- 
tion approaching  that  of  Herophilus  and  Erisistratus.  Galen  alone  can 
sustain  a  comparison  with  these  last,  by  the  great  number  of  his  experi- 
ments and  anatomico-physiological  discoveries.  In  vain  he  strove,  by 
his  example  and  exhortation,  to  awaken  in  his  cotemporaries  a  desire 
for  the  study  of  anatomy,  which,  within  proper  limits,  is  the  surest 
guide  in  practical  medicine ;  but  he  could  not  overcome  their  indiffer- 
ence. After  him,  the  practice  of  dissection  appears  to  have  been  lost, 
either  from  the  redoubled  prejudice  of  the  superstitious,  who  opposed 
dissections,  or  as  the  result  of  the  ignorant  apathy  of  the  physicians. 


CHAPTEE    III. 
HYGIENE. 


Hygiene,  during  this  period,  did  not  progress  as  rapidly  as  anatomy 
and  physiology ;  nevertheless,  it  was  not  entirely  stationary.  Celsus 
has  recapitulated,  in  his  first  book,  the  most  accredited  hygiene  precepts 
of  his  time.  He  commences  by  addressing  some  general  counsels  to 
men  in  robust  health.  Then  he  explains,  more  at  length,  the  regimen 
which  is  suitable  to  delicate  persons ;  amongst  whom  he  classes  the 
greater  part  of  the  inhabitants  of  cities,  and,  in  particular,  men  of 
sedentary  lives.  Lastly,  he  traces  the  rules  applicable  to  different  ages, 
seasons,  sea  voyages,  in  certain  idiosyncrasies,  and  other  circumstances, 
His  prescriptions  relate  principally  to  the  choice  of  food  and  drinks,  the 
use  of  baths,  the  alternation  of  repose  and  labor,  the  repast,  gymnastic 
exercises,  artificial  dejections  excited  with  a  view  to  health,  either  up- 
wards or  downwards.  If  he  adds  but  little  to  the  materials  transmitted 
by  the  writer  of  the  Hippocratic  collection,  he  has  at  least  the  merit  of 
presenting  them  with  more  order  and  precision. 


SCHOOL   OF   ALEXANDRIA.  181 

The  writings  of  Galen,  on  hygiene,  are  numerous ;  they  form  the 
whole  of  the  sixth  volume  of  the  edition  of  Chartier,  in  folio.  The 
most  considerable  are,  a  treatise  on  the  Preservation  of  Health,  divided 
into  six  books,  and  a  treatise  on  the  Qualities  of  Food,  in  three  books. 
He  divides  life  into  four  periods — infancy,  adolescence,  manhood,  and  old 
age.  He  insists  on  the  precepts  relative  to  the  first  and  last  of  these 
periods,  much  more  than  any  of  his  predecessors  had  done ;  he  enters, 
especially,  into  new  and  interesting  details  concerning  infancy.  He  has 
also  better  appreciated  than  any  other  writer,  the  influence  of  habit, 
and  was  the  first  to  feel  the  necessity  of  making  the  regulation  of  the 
passions  a  part  of  hygiene.  This  was  the  limit  of  the  eflPective  progress 
of  this  branch  of  the  art,  from  the  foundation  of  the  Alexandrian 
library  down  to  his  epoch. 

The  pure  observation  of  the  good  or  evil  which  we  realize  after  the  use  of 
certain  articles,  was  the  first  source  of  hygienic  researches,  as  is  also 
shown  by  the  following  passage  of  an  author  whom  I  have  frequently  cited : 
"  In  going  back,"  he  says,  "  to  past  ages,  I  think  that  the  regimen  of 
life  and  nutrition  which  are  employed  in  health,  in  our  days,  would  not 
have  been  discovered,  if  man,  for  his"  food  and  drink,  had  been  able  to 
content  himself  with  that  which  suffices  for  a  bullock  or  a  horse,  and 
other  creatures  out  of  the  pale  of  humanity ;  that  is,  on  simple  pro- 
ductions of  the  earth,  such  as  fruits,  herbs,  and  hay.  Animals  are  nour- 
ished by  these,  and  grow,  and  live,  without  any  inconvenience,  and  without 
the  necessity  of  any  other  alimentation.  Doubtless,  in  the  earliest  times, 
man  had  no  other  food  than  the  above,  and  that  which  he  now  employs, 
it  appears  to  me,  is  an  invention  elaborated  in  a  long  course  of  years. 
But  food  so  strong  and  crude,  would  cause  much  violent  suffering, 
as  is  realized  now,  among  those  who  sustain  themselves  on  crude, 
coarse,  indigestible,  and  exciting  food ;  intense  pain  and  diseases  are 
developed,  and  a  speedy  death.  Men  suffered  less,  doubtless,  in  the 
beginning  than  now,  on  account  of  its  habitual  use ;  nevertheless,  the 
evil  was  great  even  for  them,  and  the  greater  part,  especially  those  of  a 
feeble  constitution,  perished,  while  the  more  vigorous  could  longer  resist 
its  injurious  tendencies.  Such  was,  it  seems  to  me,  the  cause  that 
engaged  men  to  seek  a  preparation  of  food  in  harmony  with  our  nature, 
and  they  gradually  discovered  that  which  we  now  employ.  Thus  learn- 
ing how  to  macerate,  thresh,  sift,  grind,  and  knead  the  grains,  they 
fabricated  wheat  bread  and  barley  dough,  which  they  have  used  in  a 
thousand  different  forms.  They  have  boiled,  roasted,  made  compounds 
of,  and  reduced  with  weak  substances,  those  articles  which  were  too 
strong,  and  prepared  everything  to  suit  the  nature  of  man."" 

**  (Euvres  d'Hippocrate,  De  I'Ancienne  Medicine.  §  3 ;  translated  by  M.  Littre. 


182  ANATOMICAL  PERIOD. 

This  method,  both  simjDle  and  sure,  but  slow  and  timid,  did  not  suit 
the  taste  of  certain  philosophers ;  they  imagined  one  much  more  com- 
plicated, and  which  appeared  to  them  more  transcendant  and  direct. 
The  following  quotation  shows  in  what  terms  their  method  is  described 
by  one  of  those  philosophic  physicians  :  "I  maintain,"  he  says,  "  that 
to  write  well  on  the  regimen  of  man,  it  is  necessary,  in  the  first  place, 
to  be  well  instructed  as  to  his  nature,  to  know  what  man  is,  in  his 
origin,  and  what  are  the  parts  of  which  he  is  composed.  If  one  is  igno- 
rant of  his  earliest  composition,  and  what  predominates  in  his  constitu- 
tion, how  can  he  prescribe  what  may  be  useful  to  him?"" 

Such  a  course  has  something  very  seducing  in  it,  at  first  sight.  It 
attracts  by  an  appearance  of  exactness  and  profundity ;  but,  if  we  judge 
it  by  its  results,  we  shall  be  convinced,  very  soon,  that  it  is  only  cal- 
culated to  obscure  and  perplex  by  philosophic  speculations,  entirely 
ideal,  the  most  enlightened  and  experienced  minds.  The  author  from 
whom  I  have  taken  the  last  extract,  furnishes  himself  a  proof  of  this. 
He  devotes  very  vainly,  as  we  have  heretofore  remarked,  under  head  of 
Philosophic  Period,  all  the  first  part  of  his  work  to  demonstrate  that 
man  and  animals  are  a  compound  of  two  principles,  water  and  fire,  and 
he  endeavors,  then,  to  rest  on  this  philosophic  base,  his  maxims  of 
hygiene. 

Galen  has  followed  the  same  course ;  that  is,  he  endeavors  to  rest  on 
his  physiological  theories,  the  laws  relating  to  the  preservation  of 
health ;  but  this  plan  only  leads  to  digressions,  as  fastidious  for  the 
reader  as  sterile  for  science.  On  this  foundation,  he  wrote  a  book,  to 
teach  what  is  the  best  constitution  of  the  human  body,  and  what  are  the 
signs  by  which  we  may  know  it,  and  how  it  resists  the  perturbating  influ- 
ences ;  also,  another,  to  explain  what  is  to  be  infered  from  the  complex- 
ion, and  in  what  a  good  complexion  differs  from  an  athletic  one  ;  a 
third,  in  which  he  agitates,  at  great  length,  this  question,  which  may 
be  reduced  to  a  few  lines — is  hygiene  within  the  jurisdiction  of  medi- 
cine or  gymnastics  ?  Thus,  four-fifths  of  his  writings  on  hygiene,  at 
least,  may  be  dropped  or  shortened,  without  any  real  loss  to  the  art. 

Galen  gives  to  health  a  definition  conformed  to  his  theoretic  ideas ; 
but  so  unintelligible  is  it,  that  he  is  obliged  to  accompany  it  with 
an  explanatory  commentary  of  many  pages.  Here  is  his  definition : 
"  Health  consists  in  a  just  proportion  of  heat,  cold,  dryness,  and  mois- 
ture, for  similar  parts  ;  and  in  the  good  conformation,  the  exact  number, 
and  proper  extent  of  all  organic  parts."  f  In  short,  he  pretends  to 
make  all  the  precepts  of  hygiene  proceed  from  an  unique  principle. 

*'  CEuvres  d'Hippocrate,  Du  Regimen,  liv.  i.  §  2    Gardeil. 
f  De  Sanitate  Tuenda,  lib.  i,  §  1. 


.GENERAL    PATHOLOGY.  183 

"  We  know,"  lie  says,  "  that  we  must  give  similars  in  a  state  of  health, 
in  the  same  way  as  we  give  contraries  in  a  state  of  disease."  He  attempts 
to  justify  this  hygienic  axiom,  by  the  authority  of  Hippocrates,  by  logic 
and  examples  ;  but  his  arguments  are  based  on  subtilties,  only,  and  his 
axiom  is  not  equal  to  that  simple  rule,  dictated  by  instinct,  and  confirmed 
by  experience  :  Eat  only  when  you  are  hungry,  and  drink  only  when  you 
are  dry. 

This  would  be  the  place  to  speak  of  exercises,  baths,  annointings,  and 
frictions,  which  the  Greeks  and  Eomans  so  frequently  employed,  and 
which  constitute  a  part  so  important,  and  so  curious,  of  their  hygiene  ; 
but  this  subject  is  too  vast,  and  I  fear  being  drawn  into  too  long  details, 
even  if  I  should  only  attempt  to  touch  it.  I  prefer  referring  the  reader 
desirous  to  acquire  a  satisfactory  notion  of  it,  to  the  learned  work  of 
Mercurialis,  De  Arte  Gymnastica,  and  the  Histoire  de  la  Chirurgie,  by 
Peyrilhe,  vol.  II.  book  v.,  page  316. 


CHAPTEE    IV. 
GENERAL  PATHOLOGY. 

We  have  seen  that  in  the  Hippocratic  works,  the  various  branches  of 
medical  science  are  not  well  distinguished,  and  that  often,  the  same 
treatise  contains  subjects  very  distinct  from  each  other.  It  is  not  so  with 
the  most  of  the  treatises  which  we  possess  of  the  present  period  ;  they 
are  marked,  in  general,  by  a  much  more  rigid,  didactic  order.  After 
Aristotle,  and  by  the  influence  of  his  expample,  the  authors  were  much 
more  methodic  in  their  compositions.  Diseases  were  divided,  as  hereto- 
fore, into  internal  and  external,  acute  and  chronic,  according  to  their 
supposed  seat ;  but  the  authors  conformed  more  to  these  classifications, 
than  the  former  had  done.  The  treatment  was  divided  into  hygienic, 
pharmaceutic,  and  surgical.  In  fine,  it  may  be  said,  that  the  love  of 
method  was  carried  to  an  excessive  degree.  There  were  authors,  such  as 
Galen,  who,  from  a  desire  to  be  very  methodic,  fell  into  distinctions  more 
subtle  than  real,  and  lost  that  greatest  of  the  advantages  of  method, 
clearness. 

Many  historians,  among  whom  are  Leclerc  and  Sprengel,  supposed,  that 
at  that  epoch,  the  medical  profession  was  divided  into  three  orders,  which 
correspond  to  the  three  divisions  of  the  science,  shown  above.  They 
say,  that  from  that  time,  there  were  dietetic  physicians,  who  confined 
themselves  to  the  regulation  of  the  regimen  of  the  sick  ;  pharmaceutists. 


184  ANATOMICAL   PERIOD. 

who  prescribed  internal  remedies  ;  and  surgeons,  who  made  dressings 
and  performed  all  manual  operations.  Goulin  was  the  first  to  show  that 
these  statements  are  erroneous.*  Afterwards,  Shulze  demonstrated,  that 
the  division  of  j\Iedicine  into  hygiene,  pharmacy,  and  surgery,  as  intro- 
duced by  Celsus,  must  be  understood  in  a  scientific,  and  not  in  a  pro- 
fessional sense. f  Lastly,  B.  Peyrilhe,  after  having  quoted  the  opinions 
of  his  two  predecessors,  corroborates  them  by  new  considerations.  "  To 
these  opinions,"  he  says,  "  so  much  the  more  respectable,  because  they 
come  from  two  physicians  profoundly  versed  in  the  history  of  their  art, 
we  join  a  reflection  which  could  have  been  made  before,  though  it  has 
not  been  :  that  if  this  division  of  Medicine  existed  in  the  profession, 
as  it  did  in  the  Art  —  if  it  was  civil,  as  it  is  certain  that  it  was 
scholastic,  we  should  be  able  to  discern,  very  distinctly,  among  the 
Eomans,  three  classes  of  physicians.  Now,  where  shall  we  find  them  ? 
All  the  efforts  of  some  modern  investigators,  have  not  been  able  to  show 
the  existence  of  a  single  one  of  these  classes  alone.  Such,  for  example, 
as  surgeons,  that  is,  men  who  limited  themselves  to  surgical  operations.  | 


CHAPTEE    V. 
INTERNAL  PATHOLOGY. 

§  I.  Sejieiotics. 

The  Asclepiadae,  as  we  have  already  observed,  considered  morbid 
phenomena,  not  as  the  expression  of  the  suffering  of  any  particular 
part,  but  of  that  of  the  entire  economy  —  the  result  of  vital  reaction, 
excited  by  a  morbid  element.  Starting  with  this  philosophic  idea,  they 
studied  each  symptom,  independently,  without  reference  to  the  sup- 
posed state  of  the  internal  organs  of  the  body.  On  this  account,  they 
carried  Semeiotics,  or  the  knowledge  of  symptoms,  to  a  very  high 
degree  of  perfection.  These  priest-physicians  were  remarkable  for  the 
certainty  and  boldness  of  their  prognosis,  as  we  have  proof  in  many 
treatises  of  the  Hippocratic  collection. ||  We  owe  to  one  of  them  a  capi- 
tal discovery,  and  which  seemed  destined  to  give  a  new  impulse  to  this 
branch  of  the  science. 

'■'  Memoires  Littei-aires,  pour  servir  a  I'Histoire  de  la  Medicine,  annee  1775,  p- 
28,  et  suiv. 
f  Historia  Medicinse,  a  rerum  principio,  1775,  p.  28,  et  al. 

I  Histoire  de  la  Chirurgie,  de  Dujardin  et  Peyrilhe,  Paris,  1780. 

II  See,  among  others,  the  Traitc  du  Prognostic,  and  the  second  book  on  Prorrhc- 
tiques. 


INTERNAL  PATHOLOGY.  185 

Praxagoras  was  the  first  to  observe,  at  the  termination  of  the  preced- 
ing period,  the  close  connection  between  the  variations  of  the  pulse  and 
the  energy  of  vital  reaction ;  from  that  time,  it  was  thought  that  the 
regulator,  or  the  exact  measure,  of  all  the  vicissitudes  which  the  vital  prin- 
ciple experiences  in  the  course  of  the  life,  was  found.  The  slightest 
shades  of  variation  in  the  arterial  pulse  were  noted  with  the  most  scru- 
pulous attention,  and  an  effort  was  was  made  to  attach  to  each  variety 
a  detenninate  signification.  Consequently,  there  was  defined  a  pleuritic 
pulse,  that  is,  a  condition  of  the  pulse  indicating  pleurisy ;  a  suppura- 
tive and  phthisical  pulse,  and  so  on  for  each  disease.  So,  also,  there 
was  a  hepatic,  splenic,  nephrotic  pulse,  indicating  the  conditions  of 
these  organs ;  in  a  word,  they  pretended  to  be  able  to  distinguish,  by 
appreciable  variations  of  the  pulse,  all  the  modifications,  normal  or 
abnormal,  grave  or  slight,  of  the  organic  functions.  Galen  has  written 
on  this  subject  a  complete  treatise,  in  four  sections,  each  comprising  four 
books,  and  several  monographs.'--'  In  the  first  section  of  the  first  book, 
he  points  out  more  than  sixty  species  of  the  pulsef.  He  also  presents 
and  discusses  the  three  opinions,  which  prevailed  in  his  time,  on  the 
efficient  cause  of  arterial  pulsations.  Some  attributed  them  to  the 
blood,  that  each  contraction  of  the  heart  caused  to  flow  in  the  arteries  ; 
others,  that  they  were  the  effect  of  the  passage  of  the  spirits ;  others, 
again,  believed  with  Galen,  that  the  pulsative  faculty  is  transmitted 
from  the  heart  to  the  arterial  tubes,  by  continuity  of  tissue.  J 

The  Greek  Sphygmology  was  carried  to  the  Indies  by  the  disciples 
of  Herophilus  and  Erasistratus,  under  the  successors  of  Alexander  the 
Great :  thence  it  was  carried  to  China,  where  it  still  reigns,  but  dis- 
figured and  contemptible.  In  Europe,  the  Sphygmic  theory  of  Galen 
was  not  subjected  to  any  notable  variation,  till  the  discovery  of  the  cir- 
culation of  the  blood.  Xext  to  the  signs  manifested  by  the  examination 
of  the  pulse,  those  furnished  by  the  inspection  of  the  urine  occupied  the 
highest  place  in  the  semeiotics  of  the  ancients ;  but  the  chief  writings 
on  uroscopy  being  posterior  to  the  epoch  of  Galen,  we  shall  not  further 
allude  to  this  subject  now. 

To  resume :  if  we  compare  the  labors  of  the  school  of  Cos  on  semei- 
otics with  those  of  the  school  of  Alexandria,  we  shall  remark  between 
them  a  well-defined  difference.  The  Asclepiadre  grouped  together  the 
most  apparent  symptoms  of  a  disease,  and  the  circumstances  attending 

*  See  vol.  VIII,  of  his  complete  works,  edition  of  Chartier. 
flbid.,  Des  diflfe'rences  des  Pouls,  liv.  i. 

I  See  the  book  in  which  he  examines  if  the  arteries  naturally  contain  blood; 
chap,  vm.,  edition  of  Chartier,  vol.  III. 

12 


186  ANATOMICAL  PERIOD. 

their  course ;  they  founded  upon  these  the  rules  of  their  diagnosis  and 
prognosis.  The  Erasistratians,  or  Herophilians,  on  the  contrary,  regarded 
each  symptom,  or  a  single  order  of  symptoms,  separately ;  they  studied 
these  in  every  aspect — examining  their  most  delicate  shades,  and  search- 
ing, minutely,  their  causes  and  various  significations.  The  synthetic 
method  of  the  first  is  imposing,  but  is  superficial,  and  often  defective. 
The  analytic  method  of  the  second  afi'ects  exactness,  and  deep  research ; 
but  it  is  also  often  contracted  and  subtile,  and  is  lost  in  infinite  minute- 
ness. 

§  II.     NOSOGEAPHY. 

The  AsclepiadK,  as  before  remarked,  have  left  us  only  a  very  small 
number  of  nosological  descriptions  worthy  to  be  consulted.  In  their 
treatises  on  pathology,  they  follow  no  rigorous  classification,  and  do 
not  well  distinguish  the  morbid  species  from  each  other,  and  make 
no  effort  to  present,  in  a  lucid  and  natural  order,  the  symptoms,  pro- 
gress and  termination  appropriate  to  each;  in  a  word,  they  have 
neglected  to  establish  the  basis  of  the  specific  and  differential  diagnosis 
of  diseases.  This  neglect  of  so  important  a  branch  of  pathology  may 
be  explained  as  follows :  in  the  first  place,  the  defect  of  precise  notions 
on  anatomy  and  physiology  incapacitated  them,  often,  from  connect- 
ing the  functional  derangements  which  they  observed,  with  determi- 
nate organic  lesions  of  any  of  the  viscera ;  in  other  words,  it  was  often 
impossible  for  them  to  localize  diseases ;  now  that  localization  is  one  of 
the  most  solid  bases  of  all  nosological  classifications.  In  the  second  place, 
the  general  idea  that  the  ancient  Hippocratists  had  of  diseases,  pre- 
vented them  from  attaching  a  major  importance  to  the  distinctions  of 
the  morbid  species.  In  fact,  they  regarded  the  pathological  symptoms 
as  the  expression  of  a  universal  disorder,  rather  than  as  an  index  of 
the  particular  lesion  of  an  organ ;  they  had  not  made  researches,  very 
assiduously,  to  discover  what  is  the  special  viscus  affected,  when  such 
or  such  a  group  of  symptoms  was  manifested. 

Therefore,  it  may  be  said,  that  nosogi-aphy  was  still  in  its  infancy  at 
the  commencement  of  the  anatomical  period ;  but  it  was  carried  to  a 
very  high  degree  of  perfection  during  this  period,  as  is  seen  in  what 
remains  on  this  subject,  in  the  writings  of  Aretseus  and  Coelius  Aure- 
lianus.  These  two  authors  lived,  according  to  the  most  reasonable 
opinion,  in  the  second  century  of  our  era.  We  know  nothing  of  the 
lives  of  either  of  them  ;  all  that  can  be  said  positively  is,  that  the  first 
was  born  in  Cappadocia,  in  Asia  Minor,  and  that  the  second  was  a 
native  of  Sicca,  in  Numidia. 

However  this  may  be,  we  possess,  of  each  of  them,  a  treatise,  almost 
complete,  on  all  the  diseases  observed  in  their  time ;  and  these  treatises 


INTEKNAL   PATHOLOGY.  187 

constitute,  without  question,  one  of  the  most  precious  and  useful  memo- 
rials of  antique  medicine.  These  two  writers  have  arranged  their  sub- 
jects in  nearly  the  same  order.  They  have  divided  them  into  eight 
books,  of  which  the  first  four  are  devoted  to  the  description  and  treat- 
ment of  acute  diseases,  and  the  following  four  include  the  description 
and  cure  of  chronic  diseases.  But  C.  Aurelianus  mingles,  occasionally, 
with  his  subjects,  somewhat  prolix,  though  interesting  theoretic  and 
historic  dissertations ;  while  Aretasus  goes  straight  forward  to  the  end. 
without  indulging  in  any  digression. 

The  work  of  the  latter  is  written  in  Greek,  in  an  elegant,  concise, 
and  picturesque  style,  which  has  gained  him  the  reputation  of  giving 
the  finest  descriptions  of  diseases  of  any  writer  in  antiquity.  The 
work  of  Coelius,  on  the  contrary,  is  written  in  bad  Latin,  mixed  with 
many  barbarous  words,  very  difficult  to  read,  which  is  probably  the 
cause  of  its  not  being  rendered  into  our  language.  It  is,  however, 
worthy  of  being  translated,  for,  in  the  opinion  of  all  critics,  there  are 
few  among  the  works  of  antiquity  that  equal  it  in  practical  utility. 

Gralen  has  also  written,  and  even  lengthily,  on  all  diseases ;  but  his 
accounts  are  scattered  in  various  treatises,  and  buried  among  difi"use 
and  subtile  theoretic  digressions ;  so  that  to  form  an  opinion,  after  him. 
on  the  progress,  signs,  and  treatment  of  a  single  morbid  aiFection,  one 
is  compelled  to  turn  over  a  quantity  of  books,  and  to  confront  a  multi- 
tude of  passages,  oftentimes  difficult  to  understand ;  an  operation  always 
long  and  inconvenient  for  the  practitioner,  and  often  impracticable.  In 
short,  this  writer  is  neither  an  easy  guide  to  follow,  nor  an  excellent 
model  to  propose,  in  what  concerns  nosography. 

The  authors  of  this  period  describe,  with  much  detail,  the  leprosy, 
tetters,  nei-vous  headache,  and  a  multitude  of  other  chronic  affections, 
which  the  Hippocratic  writers  have  barely  mentioned,  either  because 
they  supposed  them  incurable  infirmities,  or  because,  like  Plato,  they 
regarded  them  as  simple  inconveniences,  unworthy  of  the  meditations  of 
men  of  science.  Thus,  then,  for  this  extensive  class  of  diseases,  the 
physicians  of  the  school  of  Alexandria  had  considerably  enlarged  the 
nosological  scale.  In  this  respect,  there  is  no  comparison  to  be  made 
between  their  works  and  those  of  the  school  at  Cos. 

In  regard  to  acute  affections,  with  which  the  Hippocratists  were  more 
particularly  occupied,  the  writers  of  the  anatomical  period  have  also 
added  much  to  improve  their  diagnosis,  as  may  be  seen  by  comparing 
any  disease  described  by  Aretaeus,  with  a  corresponding  description  in 
the  Hippocratic  books.  In  order  to  facilitate  this  comparison.  I  sub- 
join a  description  of  pneumonia,  which  the  reader  may  compare  with 


188  ANATOMICAL   PERIOD. 

that  which  has  been  previously  quoted,  and  which  is  one  of  the  very 
best  descriptions  of  disease,  in  the  Hippocratic  collection. 

ON   PNEUMONIA.* 

"  Two  principal  things  sustain  animal  life,  food  and  respiration  ;  but 
the  latter  more  immediately,  for  when  it  is  suppressed,  life  can  not  long 
be  sustained,  and  death  occurs  almost  instantly.  Several  parts  sub- 
serve this  function ;  the  nostrils,  where  it  begins,  the  trachea,  which  is 
its  channel,  the  lung,  which  is  its  proper  seat,  and  the  chest,  which  is 
an  inclosure  and  receptacle  of  the  lung.  But  while  the  other  structures 
named  are  only  accessory  instruments,  the  lung  contains  the  cause  of 
respiration :  for  the  heart,  which  is  the  seat  of  life  and  attraction,  is 
situated  in  the  midst  of  this  viscus,  and  communicates  to  it  the  heat 
which  it  generates,  exciting,  thus,  a  desire  for  cool  air,  which  is  the 
cause  of  respiration.  On  this  account,  when  the  heart  is  attacked, 
death  is  close  at  hand ;  but  if  the  lung  is  the  point  of  attack,  and  it 
be  moderate,  the  breathing  of  the  patient  is  difficult  and  painful,  but 
death  does  not  occur  till  a  much  later  period,  if  treatment  be  employed. 
If,  on  the  contrary,  the  attach  is  severe,  as,  for  example,  in  inflamma- 
tion, then  the  suffocation,  aphonia,  and  difficult  breathing  put  the  life 
in  jeopardy.  It  is  this  last  disease,  named  pneumonia,  that  I  now  pro- 
pose to  discuss. 

"  This  disease  manifests  itself  by  an  acute  fever,  with  a  sensation  of 
weight  in  the  chest,  without  any  pain,  if  the  lung  alone  is  inflamed ; 
for  this  organ,  being  of  a  spongy  tissue  similar  to  wool,  is  naturally 
insensible,  as  well  as  the  cartilagenous  arteries  which  are  inserted  into 
it.  It  has  no  muscles,  and  its  nerves,  being  small  and  few,  do  not  aid 
its  movements.  The  pain  is  manifested  when  some  of  the  membranes 
which  envelop  and  and  attach  it  to  the  thorax  are  inflamed. 

•'  The  breath  becomes  hot,  the  respiration  difficult,  and  the  patient 
seeks  to  be  upright,  so  that  his  breathing  may  be  easier.  The  counte- 
nance becomes  red,  especially  the  cheeks ;  the  white  of  the  eye  pearly ; 
the  nose  flat,  and  the  veins  of  the  temples  and  neck  distended.  The 
aversion  for  food  is  considerable.  The  pulse,  full  at  first,  becomes  soft 
and  small,  then  is  accelerated,  as  when  one  walks  quickly.  The  skin 
is  moderately  warm  and  moist,  but  the  patient  realizes,  internally,  a  fierce 
and  burning  heat,  which  causes  the  hot  breath,  dry  tongue,  thirst,  the 


*Aret£eus,  liv.  ii,  chap.  1.  Xotc. — This  author  prefaces,  admirably,  the  his- 
tory of  each  disease  with  some  anatomical,  physiological  considerations  on  the 
part  where  it  is  seated,  and  these  are  generally  quite  interesting. 


INTERNAL   PATHOLOGY.  189 

insatiable  desire  to  breathe  fresh  air,  and  continual  anxiety.  The  cough  is 
ordinarily  dry,  but  when  it  is  accompanied  with  expectoration,  it  is  a 
frothy  phlegm,  or  nearly  pure  bile,  or  something  sanguinolent,  of  a  rusty 
color.     This  last  kind  has  a  graver  signification  than  the  former. 

"  "When  the  disease  assumes  a  graver  caste,  the  insomnia  augments,  the 
patient  sleeps  but  little,  though  he  may  appear  to  sleep.  His  mind, 
agitated  by  a  multitude  of  incoherent  thoughts,  wanders,  but  is  easily 
aroused  to  consciousness.  It  is  seldom  that  the  alienation  is  complete. 
He  does  not  know  his  condition,  and  if  he  is  interrogated  on  that  sub- 
ject, he  replies  that  he  feels  very  well.  The  extremities  become  cold, 
the  nails  livid,  and  hooked  in  shape  ;  the  pulse  small,  frequent,  and 
scarcely  perceptible,  and  death  closes  the  scene,  generally  about  the 
seventh  day. 

"  AVhen  a  change  takes  place  for  the  better,  there  is  most  generally 
bleeding  at  the  nose,  or  a  copious  evacuation  from  the  bowels,  of  bilious 
matter,  mingled  with  froth,  which  appears  to  proceed  from  the  breast, 
also  a  flow  of  similar  material  in  the  urine.  If  it  happens  that  both  of 
these  evacuations  occur  at  the  same  time,  the  patients  soon  recover. 

"  Sometimes  a  formation  of  pus  takes  place  in  the  lungs:  in  such  a 
case,  it  is  very  fortunate  if  it  passes  off  by  the  intestines  or  blad- 
der; or,  if  it  should  make  a  metastasis  to  the  pleura,  and  an  issue 
be  established  in  the  side  of  the  chest,  so  that  it  may  pass  off,  then  the 
pneumonia  is  at  an  end.  An  ulcer  is  formed,  it  is  true,  which  may  con- 
tinue for  a  length  of  time ;  but  it  is  finally  cicatrized.  If  it  happens 
that  the  abcess  bursts  suddenly  in  the  lung,  this  rapid  effusion  of  a 
great  quantity  of  pus  suffocates  the  patient,  who  is  too  feeble  to  reject 
it  at  once ;  or  if  he  is  able  to  overcome  this,  an  ulcer  remains,  which 
causes  long  continued  suffering,  and  ends  by  throwing  him  into  phthisis. 
It  is  as  rare  for  old  men  to  survive  such  an  ulceration,  as  it  is  for  young 
men,  and  persons  in  the  vigor  of  life,  to  resist  the  violence  of  the  iufla- 
mation." 

The  above  is  a  well  drawn  picture  of  a  disease,  in  which  nothing 
essential  is  wanting,  nor  is  the  description  too  lengthy.  More  details 
might  have  been  given  ;  but  none  of  the  principal  features  of  peripneu- 
monia, as  the  disease  was  then  known,  have  been  omitted.  All  its 
features  are  traced  in  a  natural  order,  and  easy  to  be  remembered  ;  so 
much  so,  that  after  having  read  and  meditated  on  this  nosological  tableau, 
the  whole  picture  may  be  recalled  at  any  future  time,  when  in  the 
presence  of  a  disease  that  offers  such  characteristic  traits,  and  a  judg- 
ment be  established  of  the  present  condition  and  future  prospects  of 
the  patient,  and  the  therepeutical  course  that  should  be  adopted.  The 
Hippocratic  collection  contains  not  a  single  description  of  a  disease,  that 


190  ANATOMICAL   PERIOD. 

can  be  put  in  comparison  with  this.  The  work  of  Aretaeus  contains, 
besides,  a  series  of  nosological  descriptions  equally  as  good.  An  opinion 
may  be  formed  by  the  comparison,  of  the  progress  that  this  branch  of 
the  science  made  since  the  last  of  the  Asclepiadse. 


C  H  A  P  T  E  E    Y  I . 
INTERNAL  THERAPEUTICS. 

iSTo  new  therapeutical  axiom  was  proclaimed  during  this  period ;  the 
edifice  of  the  profession  was  still  based  on  the  foundation  laid  by  the 
Hippocratists,  which  consisted,  it  is  said,  in  employing  such  curative 
means  as  would  be  contrary  in  their  action  in  the  economy,  to  the  gene- 
rative cause  of  the  disease,  or  to  the  primitive  and  essential  lesion,  to 
which  all  the  other  symptoms  are  connected.  Consequently,  great  efforts 
were  made  to  ascertain  exactly,  for  each  nosological  species,  its  origin, 
its  determining  cause,  or  the  phenomena  which  essentially  constitute  it. 
Then  search  was  made  among  known  remedies,  for  those  whose  physio- 
logical action  was  the  most  directly  opposite  to  the  essence  of  the  disease. 
Such  was,  in  general,  the  mode  of  reasoning,  of  the  physicians  of  this 
epoch. 

However,  a  famous  sect  called  the  Empirics,  arrayed  themselves 
against  this  method.  They  pretended  that  the  immediate  cause,  or 
essential  lesion  of  diseases  being  impenetrable,  so  is  also,  the  primitive 
action  of  curative  agents ;  and  to  establish  medicine  on  such  a  founda- 
tion, was  nothing  more  than  building  on  the  sand,  or  rather  on  chimeras. 
We  shall  recur,  at  a  proper  time,  to  the  arguments  adduced  on  both 
sides ;  for  a  very  lively  and  interesting  discussion  arose  on  this  subject, 
amongst  the  various  medical  sects  of  the  Alexandrian  school,  and  great 
light  emanated  from  the  midst  of  these  discussions.  But,  at  present,  I 
wish  only  to  take  a  practical  view  of  the  science,  and  in  this  respect, 
therapeutics  made  great  acquisition  during  this  period. 

Medical  natural  history  did  not  exist  in  the  times  of  the  Asclepiadae ; 
for  we  do  not  find  in  their  writings,  any  methodic  descriptions  of  sub- 
stances employed  in  medicine,  nor  any  effort  to  classify  remedies. 
Aristotle  offers  the  fii'st  model  of  a  collection  of  the  products  of  nature, 
undertaken  with  a  scientific  aim.  His  attention  was  directed  particularly 
towards  zoology,  and  he  made  in  that  branch  of  the  science  of  natural 
history,  discoveries  which  would  have  been  sufficient  to  immortalize 
his  name. 


INTERNAL  PATHOLOGY.  191 

After  him,  Theophrastus,  inheritor  of  his  manuscripts  and  his 
museum,  continued  to  direct  the  Peripatecian  school,  in  natural  studies. 
He  did  for  botany,  what  his  master  had  done  for  zoology.  He  observed 
the  internal  and  external  conformation  of  vegetables,  their  modes  of 
nutrition,  flowering  and  fructification ;  in  a  word,  created  vegetable 
physiology.  He  described  the  physical  qualities  and  medicinal  virtues 
of  more  than  five  hundred  plants. 

The  sovereigns  of  Egypt  made  still  more  extensive  collections,  which 
they  placed  at  the  disposal  of  the  savans  of  Alexandria ;  consequently, 
they  studied  the  properties  of  a  mass  of  new  substances,  with  which 
they  enriched  the  materia  medica.  Towards  the  end  of  this  period,  the 
luxury  of  compound  preparations  and  exotic  remedies  became  common 
at  Eome,  and  throughout  the  empire,  and  polypharmacy  was  pushed  to 
a  ridiculous  extent.  Then  were  invented  those  famous  antidotes  known 
by  the  name  of  mithridate,  theriaque,  in  which  were  compounded  from 
forty  to  sixty  different  ingredients.  It  was  supposed  that  each  of  these 
medicinal  substances  preserved  its  proper  virtues,  in  the  midst  of  the 
common  amalgam,  which  possessed  the  properties  of  all  the  drugs  that 
entered  into  its  composition,  and  thus  formed  a  sort  of  panacea,  good 
for  all  diseases. 

The  description  of  a  great  number  of  morbid  conditions  created  the 
necessity  of  a  pathological  classification  ;  so,  in  like  manner,  from  the 
multiplicity  of  medical  substances,  originated  the  want  of  a  pharmaceu- 
tical classification.  Three  authors,  towards  the  close  of  this  period, 
Dioscorides,  Pliny,  and  Galen,  undertook  to  supply  this  vacancy.  Their 
works  on  materia  medica  have  been  preserved ;  but  that  of  Dioscorides 
is  the  most  esteemed,  for  its  order,  clearness,  and  exactness ;  therefore  I 
shall  say  a  few  words  about  it. 

The  author  states  in  the  preface,  that  he  is  the  first  who  has  made 
mention  of  aromatic  substances,  as  well  as  remedies  drawn  from  the 
mineral  kingdom.  He  divides  his  treatise  into  six  books :  the  first 
treats  of  odorous  substances,  such  as  oils,  ointments,  woods,  juices, 
fruits,  gums,  and  resins;  the  second,  of  animals,  of  honey,  milk,  fats, 
and  the  herbs  and  seeds  of  the  gardens ;  the  third,  of  roots,  herbs, 
juices,  and  grains,  which  serve  for  domestic  uses ;  the  fourth,  perennial 
herbs  and  roots ;  the  fifth,  of  the  vine,  wines  of  all  kinds,  and  minerals  ; 
lastly,  the  sixth  of  vegetable  and  animal  poisons.  It  is  plain,  that  such 
a  classification  of  medical  substances  is  confused  and  arbitrary. 

The  natural  characters  of  these  same  substances  are  no  better  deter- 
mined ;  sometimes,  indeed,  they  are  pointed  out  with  so  little  exactness, 
and  so  few  of  them  are  mentioned,  that  it  is  impossible  to  recognize  the 
plant  or  the  mineral  in  question.     Again,  they  are  not  indicated  at  all ; 


192  ANATOMICAL   PERIOD. 

and,  after  naming  a  substance,  he  has  contented  himself  with  describing 
its  medical  virtues.  The  following  is  one  of  the  best  descriptions  in 
the  whole  collection :  "  The  nettle  is  of  two  species ;  in  one  of  which, 
the  leaves  are  more  irregular,  rougher,  larger,  and  blacker,  than  in  the 
other,  and  the  seeds  are  like  those  of  flax,  but  smaller.  The  leaves  of 
the  other  species  are  not  so  rough,  and  the  seeds  are  not  as  thick.  The 
leaves  of  both,  rubbed  up  with  salt,  form  a  good  salve  with  which  to 
dress  the  bite  of  dogs,  gangrenous  sores,  chancres,  open  ulcers  that  are 
difficult  to  consolidate;  also,  denuded  parts,  small  tumors,  or  ruptured 
abcess,  and  those  which  are  named  parotidotic.  Applied  with  wax,  it 
relieves  the  difficulties  of  the  spleen.  Eubbed  up  with  syrup  and  applied 
to  the  nostrils,  it  restrains  the  flow  of  blood ;  bruised  with  myrrh  and 
applied  as  a  pessary,  it  provokes  the  menstrual  flux.  In  touching  the 
womb  with  it,  fresh,  it  relaxes,  and  assumes  its  natural  position.  The 
seeds,  drank  in  boiled  wine,  excite  wanton  desires.  It  opens  the  mouth 
of  the  uterus.  When  used  sparingly  with  honey,  it  is  advantageous  in 
difficulties  in  the  chest,  pains  in  the  side,  and  inflammation  of  the  lungs- 
It  purges  the  chest.  It  may  be  mingled  with  corrosive  medicines.  The 
leaves,  stewed  with  some  other  substances,  increase  the  urine,  and 
relieve  flatulency.  Drunk  with  myrrh,  they  produce  the  menstrual  flux. 
The  syrup,  used  as  a  gargle,  heals  inflammation  of  the  soft  palate.=--= 

The  materia  medica  was,  therefore,  considerably  enriched  by  the 
labors  of  the  anatomical  school ;  on  the  other  hand,  the  diagnosis  of 
diseases  was  greatly  improved.  The  curative  indications  had  become 
more  precise,  from  which  we  may  conclude,  a  priori,  that  the  therapeu- 
tics of  the  physicians  of  this  period  became  more  rational  and  precise 
than  that  of  the  Asclepiadfe.  The  treatment  of  acute  diseases  is  also 
described  with  more  method  and  exactness,  than  in  the  authors  of  the 
Hippocratic  collection.  This  may  be  seen  by  comparing  the  treatment 
of  peripneumonia,  traced  by  the  latter,  with  that  laid  down  in  the  work 
of  Aretaeus. 

CURE   FOE   PERIPNEUMONIA. 

"  When  the  lung  is  inflamed  and  swollen,  the  affliction  is  acute,  and 
promptly  fatal ;  for  suifocation  is  close  at  hand.  Prompt  aid  must  be 
afi"orded,  equal  to  the  severity  of  the  attack.  A  venesection  must  be 
made  at  once,  and  from  both  arms,  in  order  to  efi^ect  on  both  sides  a 
revulsion  of  humors  from  the  lung.  The  bleeding  must  not  be  carried  to 
syncope,  for  fear  of  augmenting  the  suffocation.  When  the  patient  com- 
mences breathing  more  freely,  the  bleeding  should  be  stopped ;  to  be 

'-  Dioscorides  d'Aiiazarbas  :  De  la  Matiere  Medicale,  book  iv,  chap,  lxxix. — 
French  translation,  by  Mathiolus,  Lyons,  1580. 


INTERNAL   PATHOLOGY.  193 

employed  again,  if  necessary.  There  is  nothing,  in  fact,  hut  the  hleed- 
ing,  that  can  destroy  the  disease,  if  it  proceeds  from  the  hlood ;  and 
even  in  cases  where  the  phlegm,  froth,  or  any  other  humor  of  that  spe- 
cies, distends  the  lungs,  it  would  still  be  useful  in  disgorging  it,  and 
procuring  a  free  space  for  respiration. 

"  After  the  bleeding,  an  effort  should  be  made  to  direct  the  humor  and 
wind  by  the  inferior  channels.  To  effect  this,  the  anus  should  be 
anointed  with  a  liniment  composed  of  honey,  rue,  a  terebinthenate 
liquid  and  nitre,  mingled  together.  In  a  case  where  venesection  is 
impracticable,  on  account  of  great  effusion,  an  injection  should  be  made 
into  the  fundament,  in  the  form  of  clysters,  of  some  tart  substance — for 
example,  of  salt  with  nitre;  turpentine  with  honey;  or  rue  boiled  in  oil ; 
or  a  decoction  of  hyssop.  The  pulp  of  colocynth,  boiled  in  water,  is  also 
very  convenient.  It  will  also  be  useful  to  apply  dry  cups,  along  the 
spine,  on  the  hypochondria,  and  wherever  they  can  be  used.  The  fleshy 
parts  of  the  chest  are  to  be  preferred,  from  fear  that  the  cup  will  fall  off. 
If,  by  this  means,  the  humors  can  be  attracted  to  some  other  part,  and 
the  flatus  that  swells  the  lungs  be  dispersed,  the  patient  will  obtain 
great  relief;  but  it  is  necessary,  in  some  way,  to  besiege  every  part,  in 
pneumonia. 

"  In  the  meanwhile,  those  remedies  which  can  be  taken  with  most 
advantage  by  the  mouth,  should  not  be  neglected,  especially  as  the 
lung,  whether  sound  or  diseased,  attracts  humidity.  Therefore,  reme- 
dies should  be  employed  that  attenuate  the  humors,  and  render  them 
less  tenacious,  more  mobile,  and  easier  to  be  expectorated.  To  effect 
this  speedily,  and  thus  relieve  the  patient,  a  decoction  of  nitred  hyssop 
should  be  given  ;  or  of  brine,  mingled  with  vinegar  and  honey  ;  or  an 
infusion  of  mustard,  in  an  emulsion  of  water.  If  to  each  of  these 
preparations  there  be  added,  freely,  those  of  the  root  of  the  iris,  and 
pulverized  pepper,  it  will  be  found  very  good.  So,  also,  these  powders 
may  be  sifted,  mingled  with  honey,  and  given  to  the  patient.  If  he 
pass  several  days  and  nights  without  sleep,  there  is  reason  to  fear  that 
he  will  fall  into  a  furious  delirium.  Unless  the  disease  abates,  somni- 
ferous medicines  are  to  be  used,  to  calm  the  patient,  produce  sleep,  and 
prevent  this  unfortunate  state.  There  is  a  great  variety  of  such  reme- 
dies, which  may  be  employed  ;  but  care  must  be  taken  not  to  give  them 
when  the  patient  is  on  the  point  of  suffocation  by  the  fluxion,  for  fear 
of  creating  an  impression  in  the  bystanders,  that  your  remedy  has 
killed  him. 

"  Aliment  must  be  used,  that  acts  in  harmony  with  the  remedies,  and 
should,  therefore,  be  somewhat  bitter,  sharp,  attenuating,  and  detersive. 
Among   the   legumes,  leeks,  cresses,   nettles,   and  cabbage,   cooked  in 


194  ANATOMICAL  PERIOD. 

vinegar,  should  be  cliosen.  Among  the  farinaceous  substances,  vegetable 
soup,  to  which  is  added  marjoram,  or  hyssop,  spiced  with  a  little  pepper, 
or  nitre,  instead  of  salt,  alique,  boiled  in  sweetened  water.  All  these 
substances  should  be  boiled,  in  order  to  expel  the  air,  which  is  very 
incommodious  to  peripneumonics. 

"  When  the  patients  are  without  fever,  a  little  wine  may  be  allowed, 
provided  it  is  not  too  astringent ;  for  in  this  disease  there  is  need  of 
relaxation,  rather  than  constriction,  so  that  expectoration  may  be  facili- 
tated. In  general,  the  patient  should  have  but  little  to  drink,  for  the 
lung  attracts  the  humidity  of  the  esophagus  and  stomach,  which  is 
injurious. 

"  The  chest  should  be  covered  with  wool,  saturated  with  oil,  in  which 
a  little  nitre  or  salt  has  been  dissolved.  Fomentations  should  be  made, 
occasionally,  with  snail  oil.  A  useful  liniment,  in  such  cases,  is  com- 
posed of  dry  mustard,  mixed  with  cerato.  In  short,  everything  that 
can  draw  outward  the  humors,  heat,  and  wind,  must  be  employed  ;  such 
as  irritant  substances  to  the  nostrils,  different  kinds  of  ^ointment,  and 
ligatures  on  the  extremities,  are  some  of  the  means  to  be  employed. 
If,  after  all  these  things  have  been  employed,  the  disease  does  not  abate, 
the  case  must  be  regarded  as  desperate." 

The  above  account,  except  in  some  small  particulars,  would  not  detract 
from  a  modern  work  on  the  practice  of  Medicine.  If  placed  in  par- 
allel with  the  prescriptions  directed  by  the  Hippocratic  writers,  it  will 
be  seen,  that  there  is  no  comparison,  whatever,  to  be  established.  Thus, 
in  the  space  of  four  centuries,  which  separate  the  last  of  the  Asclepiadse 
from  the  epoch  in  which  Aretreus  lived,  a  greater  progress  in  the  diag- 
nosis and  treatment  of  certain  diseases  was  made,  than  has  been  effected 
since,  in  a  course  of  more  than  sixteen  hundred  years. 


CHAPTER    VII. 

EXTERNAL  PATHOLOGY  AND  THERAPEUTICS. 

The  want  of  anatomical  knowledge  was  an  insurmountable  obstacle 
to  the  progress  of  surgery,  under  the  Asclepiadas.  They  did  not  lack 
boldness  to  attempt  difficult  and  dangerous  operations,  but  they  lacked 
methodic  and  correct  procedures,  because  the  hand  of  the  operator  was 
not  guided  by  a  knowledge  of  anatomy.  But  after  the  anatomical  labors 
of  the  school  of  Alexandria  had  thrown  so  much  light  on  the  conforma- 
tion of  our  organs,  operative  medicine  must  have  assumed  a  new  phase ; 


EXTERNAL   PATHOLOGY  AND  THERAPEUTICS.  195 

and  this  we  see  exhibited  in  the  works  of  Celsus  and  Galen,  in  which 
the  surgical  parts  are  incontestably  superior  to  those  of  the  Hippocratic 
books.  A  short  analysis  of  the  surgery  of  Celsus  will  suffice  to  make 
this  evident. 

This  author,  according  to  all  evidence,  lived  toward  the  close  of  the 
first  century  of  the  Christian  era,  that  is  to  say,  a  little  in  advance  of 
Galen.  He  wrote  on  a  great  number  of  subjects,  such  as  architecture, 
rhetoric,  philosophy,  military  tactics,  etc.,  but  of  all  his  works,  those 
on  Medicine  alone  have  reached  us.  It  forms  a  methodic  abridgement, 
extremely  complete  and  concise,  of  all  ancient  Medicine.  The  author, 
in  the  commencement,  gives  a  rapid  view  of  the  origin  and  first  develop- 
ment and  progress  of  the  Art,  and  the  sects  into  which  the  medical 
men  of  his  time  were  divided.  He  exercises,  on  each  of  these  subjects, 
an  excellent  judgment ;  then  he  traces  a  regimen  for  men  in  good 
health,  and  for  those  who  are  valetudinarian.  With  these  subjects  he 
fills  the  first  two  books  of  the  Compendium.  The  four  following,  are 
devoted  to  the  description  and  cure  of  diseases  susceptible  of  being 
cured  by  the  aid  of  regimen  and  pharmaceutical  means. 

Finally,  the  last  two  books,  i.  e.,  the  seventh  and  eighth,  include  the 
accounts  of  cases  in  which  the  aid  of  surgery  is  judged  indispensable, 
with  a  description  of  the  operations  then  in  use.  Celsus  has  contracted 
in  a  small  space  all  the  surgical  knowledge  of  the  ancients.  He  treats 
not  only  of  all  matters  contained  in  the  Hippocratic  writings,  but  also 
of  a  multitude  of  others,  of  which  these  books  make  no  mention. 
Among  the  chapters  entirely  new,  we  cite  those  relating  to  the  relief  of 
hernia,  vesicular  calculi,  cataract,  wounds  of  the  abdomen  and  intes- 
tines, etc.,  which  form,  as  we  know,  a  considerable  part  of  surgery. 
His  arrangement  of  the  work  is  sufficiently  correct  and  natural.  He 
commences  by  treating  of  the  diseases  which  attack  all  parts  of  the 
body ;  then  he  passes  to  those  which  relate  especially  to  each  part.  His 
work  is  the  only  one,  of  that  distant  period,  in  which  we  find  the  opera- 
tive processes  described  with  clearness  and  precision ;  the  writings  of 
all  the  distinguished  surgeons,  from  the  foundation  of  the  Alexandrian 
school  until  his  time,  being  entirely  lost.  He  names,  himself,  several  of 
them,  such  as  Triphon,  Evelpist,  and  Meges,  the  wisest  of  all. 

I  will  not  examine  the  question,  so  many  times  asked  and  still  unde- 
cided, if  Celsus  himself  was  a  practitioner ;  that  is  of  little  moment  to 
us ;  but  it  is  important  for  us  to  have  a  summary  idea  of  the  progress 
made  in  surgery  during  the  course  of  the  Anatomic  Period.  Now,  to 
obtain  this,  it  will  suffice,  I  think,  to  exhibit  some  fragments  of  the 
latter  author,  in  parallel  with  those  of  the  Hippocratic  collection,  which 
treat  of  the  same  subjects. 


196  ANATOMICAL  PERIOD. 


ON  HEMOERHAGE. 


"  In  Hippocrates,  the  word  aiiioppayai  always  signifies  a  hemorrhage, 
in  which  the  blood  flows  freely  and  forcibly.  When  less  blood  flows, 
and  slower,  he  calls  it  eppvacv,  and  azaXaynou  when  it  flows  only  drop 
by  drop.  He  prognosticates  that,  when  an  unnatural  effusion  of  blood 
takes  place  in  any  cavity  of  the  body  whatever,  it  certainly  becomes 
spoiled.  It  appears  that  he  stopped  the  hemorrhage  of  wounds  by  filling 
them  with  a  substance  so  as  to  produce  compression.  Sometimes,  again,  by 
the  application  of  fire.  In  dressing  wounds,  he  used  a  sponge  rather  than 
charpie,  which  was  improper,  because  the  sponge,  by  imbibing  pus  and 
other  fluids,  swells  up,  separates  the  edges,  and  prevents  re-union.  "=•■■= 

This  is  all  that  the  author  of  the  history  of  surgery  has  been  able  to 
collect  in  the  Hippocratic  works,  concerning  hemorrhage.  Let  us  now 
see  what  the  same  author  has  extracted  from  the  work  of  Celsus.  "As 
soon  as  we  are  assured,"  he  says,  "  by  the  signs  heretofore  given,  that 
the  wound  may  be  healed,  Celsus  directs  that  attention  be  given  to  pre- 
vent the  hemorrhage,  or  inflammation,  from  causing  the  death  of  the 
patient.  Now,  we  know  that  a  hemorrhage  is  to  be  dreaded,  according  to 
its  seat,  the  extent  of  the  wound,  and  the  rapidity  of  the  flow  of  blood. 
Then  he  directs  that  the  wound  be  filled  with  dry  charpie,  and  a  sponge, 
dipped  in  cold  water,  be  held  upon  it.  If,  however,  the  hemorrhage  con- 
tinues, he  suggests  that  the  charpie  be  frequently  wet  with  vinegar. 
Some  surgeons  of  his  time  poured  it  into  the  wound ;  but  he  objects  to 
this  proceeding ;  fearing  that  the  sudden  retention  of  the  fluids  would 
lead  to  a  violent  inflammation ;  but  this  could  only  relate  to  aponeurotic 
parts.  This  view  led  him,  also,  to  proscribe  the  use  of  corrosives  and 
escarotics,  though  proper  to  arrest  hemorrhage.  If  they  must  be  em- 
ployed, he  recommended  that  the  mildest  be  chosen. 

"  If  the  hemorrhage  resists  these  remedies,  he  advises  that  two  ligatures 
be  made  of  the  vessel,  at  the  point  of  injury,  and  the  intervening  por- 
tion be  divided.  There  was  only  one  step  to  take,  between  this  and  the 
ligatures  of  the  vessel,  in  amputations ;  yet  it  required  centuries  to  take 
it.  If  the  ligature  was  impracticable,  he  proposes  the  actual  cautery, 
provided  the  wound  has  bled  enough,  and  that  there  are  no  nerves  or 
muscles  in  the  wounded  part,  as  on  the  forehead  and  top  of  the  head ; 
parts  which  they  believed  destitute  of  these  tissues ;  but  this  application 
could  only  afford  a  doubtful  result.  It  was  still  the  habit  to  apply  cups  to 
an  opposite  part,  in  order  to  determine  the  flow  of  blood  from  the  wound ; 
but  it  is  plain  that,  under  the  circumstances,  they  could  be  of  no  utility.f " 

*'Dujarclin,  Histoire  de  la  Chirurgie,  vol.  I,  book  iti,  p.  210. 
flbid.,  vol.  I,  book  it,  p.  372. 


{ 


EXTERNAL  PATHOLOGY  AND  THERAPEUTICS.  197 

There  is  no  necessity  for  me  to  show  in  what  respect  the  advice  of 
Celsus.  on  this  occasion,  is  more  detailed,  more  methodic  and  rational, 
than  that  of  the  Hippocratic  writers.  I  shall  content  myself  by  adding 
another  example. 

ON  THE  EXTEACnON  OF  THE  DEAB  FETUS. 

"  If  we  compare,"  says  the  same  historian,  "  the  cruel  method  em- 
ployed by  Hippocrates,  to  take  away  the  fetus,  with  the  practice  of  our 
time,  we  shall  see  that,  in  this  respect,  surgery  has  also  made  much 
progress.  To  extract  a  dead  fetus,  he  introduced  his  hand,  covered  with 
cerate,  into  the  womb,  having  his  thumb  armed  with  a  sharp  instru- 
ment, which  was  termed  a  claw.  He  cut  off  first,  the  arms,  and  with- 
drew them ;  the  hand  was  then  returned  to  the  womb,  and  the  abdomen 
of  the  fetus  was  opened,  and  the  entrails  slowly  withdrawn  ;  lastly, 
the  ribs  were  broken,  in  order  to  reduce  the  size  of  the  chest,  so  as  to 
render  the  extraction  easy.  He  gives  another  process,  quite  as  terrifying. 
"When  the  dead  fetus  is  situated  obliquely  in  the  uterus,  presenting  an 
arm,  he  covered  the  head  and  chest  of  the  mother,  in  order  to  prevent 
her  seeing  the  operation  ;  then  he  seized  the  arm,  drew  it  without,  and 
amputated  it  at  the  shoulder-joint.  He  next  made  an  opening  in  its 
chest,  below  the  clavicle,  and  several  smaller  ones  in  the  abdomen,  to 
allow  the  air  to  escape.  An  effort  was  now  made,  to  get  hold  of  the 
head,  so  as  to  withdraw  the  fetus  entire.  If  this  was  unsuccessful,  he 
crushed  the  head,  and  brought  away  the  body  piecemeal." 

"  It  remains,  now,  to  detail  with  Celsus,  how  the  accouchement  was 
terminated,  when  the  infant  was  presented  dead.  After  placing  the 
woman  on  her  back,  across  the  bed,  the  thighs  were  to  be  held  apart, 
the  indicator,  greased  with  oil,  was  introduced  into  the  uterus,  and  then, 
in  the  interval  of  the  pains,  the  other  fingers,  successively,  and,  finally, 
the  whole  hand.  There  were  occasions,  he  says,  when  both  hands  were 
introduced,  which  is  not  easily  conceived.  Celsus  remarks,  very  pro- 
perly, that  when  the  hand  is  introduced  into  the  uterus,  it  is  at  once 
recognized  whether  the  infant  presents  the  head,  or  the  feet,  or  trans- 
versely. In  this  latter  situation,  the  hands  or  the  feet  are  not  very 
far  from  the  os  uteri,  and  the  practitioner  should  endeavor  to  make  the 
head  or  the  feet  the  presenting  part ;  for  it  is  well  known,  that  next  to 
the  head,  the  feet  are  the  more  natural  and  advantageous  presentation 
for  delivery.  This  plan  is  a  great  improvement  in  obstetrics,  since  the 
time  of  Hippocrates. 

"  When  the  child  presents  an  arm,  an  effort  should  be  made  to  deliver 

"  Dujardin,  Histoire  de  la  Chirurgie.  CEuvres  d'Hippocrate,  De  la  Superfeta- 
tion.     De  I'Extraction  du  fetus  mort.     Maladies  des  femmes. 


198  ANATOMICAL   PERIOD. 

by  the  head  ;  if  it  was  a  foot,  the  other  should  be  sought.  In  this  case, 
the  accouchement  can  not  be  suj)posed  difficult,  even  by  the  hand  alone. 
When  the  head  comes  down,  a  very  smooth  and  short-beaked  crotchet  is 
to  be  fastened  in  the  orbit,  or  the  mouth,  or  in  the  ear,  and  sometimes 
in  the  forehead,  so  as  to  hasten  the  delivery.  Celsus  says,  if  traction 
is  made  while  the  orifice  of  the  womb  is  contracted,  the  crotchet  may 
slip  from  the  part  to  which  it  is  fastened,  fall  upon  the  undilated  orifice, 
excite  convulsions,  and  j^lace  the  life  of  the  mother  in  the  most  immi- 
nent danger.  Consequently,  he  orders,  that  traction  be  made  gradually, 
and  only  at  periods  of  relaxation,  and  without  violence.  While  the 
operator  draws  upon  the  instrument  with  his  right  hand,  the  left  is  to 
be  engaged  in  directing  the  crotchet,  and  the  position  of  the  child." 

"  If  version  can  not  be  effected,  when  the  fetus  is  in  the  transverse 
position,  the  crotchet  must  be  fastened  in  the  axilla,  and  traction  be 
made  gradually.  As  the  head  is  carried  backward,  it  is  to  be  separated 
from  the  trunk,  and  then  the  separated  portions  are  to  be  removed  suc- 
cessively. To  do  this,  a  crotchet  similar  to  the  first  was  employed, 
excepting  that  its  internal  edge  was  sharp.  The  head  was  first  with- 
drawn, because  it  was  thought  that  if  the  trunk,  which  is  the  most  vol- 
uminous, was  first  delivered,  the  head  could  not  afterwards  be  taken 
away  without  extreme  danger  ;  nevertheless,  if  the  operator  must  finish 
with  the  head,  he  commenced  by  laying  on  the  abdomen  of  the  woman 
a  piece  of  linen,  folded  double  ;  then,  an  intelligent  and  strong  man 
must  be  placed  at  the  left  side  of  the  woman,  and  apply  both  his  hands 
to  the  abdomen,  one  placed  on  the  other,  and  press  the  head  toward  the 
orifice  of  the  womb,  which  the  surgeon  must  seize  with  the  crotchet, 
and  withdraw,  in  the  manner  prescribed.  Though  this  procedure  is 
unnatural,  it  can  not  be  denied  that,  in  general,  this  manual  of  diffi- 
cult labor,  described  by  Celsus,  is  more  rational  and  methodic  than  that 
of  Hippocrates  ;  notwithstanding  the  few  occasions  in  which  men  were 
called  upon  to  act,  in  the  important  function  of  maternity."  ■•■= 

I  should  have  been  willing  to  abridge  these  quotations,  and  many 
others  that  are  passed,  as  well  as  those  that  are  to  come  ;  but  after 
deliberate  reflection,  I  have  concluded  to  present  the  thoughts  of  authors 
in  their  own  style,  rather  than  abridge  them  by  incomplete  quotations; 
or  alter  them  by  analysis  ;  I  employ  this  last  means,  only  when  I  can 
not  do  otherwise.  It  has  appeared  to  me,  that  one  of  the  principa 
objects  of  the  history  being  to  offer  the  reader  a  succinct  narration,  as 
exact  as  possible,  of  the  vicissitudes  of  medical  science,  it  would  be 
better  to  furnish  him,  often,  with  the  means  of  judging  for  himself,  by 

«  Histoire  de  la  CMrurgie,  T.  I,  liv.  iv,  p.  496.    Celae,  liv.  vii,  chap.  xxix. 


CLINICS.  199 

placing  before  him,  in  some  sort,  the  various  documents  on  the  subject, 
than  to  present  him  a  ready  formed  opinion.  The  advantages  of  this 
method  seem  to  me  so  clear,  that  I  do  not  think  it  necessary  to  argue  it 
at  length. 


CHAPTER    VIII. 
CLmiCS. 

Clinics,  as  before  remarked,  is  not  a  particular  branch  of  medical 
science  ;  it  is  the  science  itself,  in  its  practical  application  ;  it  is 
the  battle-field  of  the  physician ;  the  theater  where  he  displays  not 
only  all  the  resources  of  his  art,  but,  also,  of  his  genius,  as  well  as  the 
qualities  of  his  soul.  A  high  intellectual  capacity  is  doubtless  the 
first  condition  that  constitutes  the  great  practitioner ;  but  this  is  not 
sufficient ;  there  are,  also,  necessary,  constant  watchfulness,  and  pres- 
ence of  mind,  which  will  enable  him  to  seize  passing  indications  ;  firm- 
ness of  character,  that  prevents  him  being  troubled  under  the  most 
painful  circumstances,  and  which  gives  him  courage  to  take  a  resolu- 
tion, without  being  disturbed  by  unjust  and  calumnious  conversation  — 
fearlessly  risking  his  reputation  for  the  salvation  of  his  patients. 

A  great  practitioner  must  show  himself,  in  all  his  acts,  a  constant 
advocate  of  truth.  He  must  not  palliate  his  reverses,  or  his  faults, 
nor  exagerate  his  success,  for  he  is  not  ignorant  that  both  serve  as 
lessons ;  and  that,  in  his  elevated  position,  to  hide  the  truth,  or  speak 
falsely,  is  to  pave  the  way  for  future  homicides. 

Such  are  the  qualities  that  shine  in  the  clinical  histories  unanimously 
attributed  to  Hippocrates,  in  the  first  and  third  books  on  Epidemics. 
In  no  other  part  of  his  writings  are  they  so  conspicuous  as  in  these 
books.  The  anatomic  period,  during  which  the  Art  made  such  great 
progress,  has  not  transmitted  to  us  any  collection  of  clinical  observations 
worthy  to  be  compared  with  these  ;  whether  the  works  of  the  illustrious 
practitioners  of  this  period  perished  in  the  destruction  of  the  great 
libraries,  or  whether,  during  this  long  period,  there  did  not  exist  any 
man  who  united  in  himself,  in  so  eminent  a  degree  as  the  old  man  of 
Cos,  all  the  qualities  which  constitute  the  great  practitioner,  I  do  not 
pretend  to  say.  Galen,  who  alone,  among  the  physicians  of  this  period, 
can  sustain  advantageously  a  comparison  with  Hippocrates,  by  the  gen- 
eral character  of  his  acquirements,  and  the  multitude  of  his  writings, 
has  left  us  no  collection  of  clinical  observations.  He  reports,  now  and 
then,  the  history  of  some  diseases,  but  for  the  evident  purpose  of  showing 


200  ANATOMICAL   PERIOD. 

the  superiority  of  his  diagnosis,  and  the  excellency  of  his  theory.  We 
do  not  see  in  his  recitals,  as  in  Hippocrates'  lively  pictures  of  epidemical 
constitutions,  the  naive  and  impartial  historian,  who  gives  his  facts 
without  comment ;  but  we  everywhere  find,  on  the  contrary,  the  prolix  and 
subtle  dialectician,  who  lets  no  phenomenon  escape  him,  without  inter- 
preting and  discussing  it,  in  a  lengthy  manner. 

APHORISMS. 

Many  writers  of  this  period,  and  Galen  among  the  rest,  commented 
upon  the  Hippocratic  aphorisms,  but  no  one  attempted  to  construct  new 
ones.  The  greater  part  were  doubtless  maintained,  from  the  respect 
which  was  held  for  the  ancient  oracles,  whose  reputation  was  colossal ; 
it  may  be,  too,  they  feared  the  abuse  to  which  this  kind  of  literature  in 
Medicine,  more  pretentious  than  solid,  would  lead.  Be  this  as  it  may, 
we  shall  not  reproach  the  authors  in  this  period,  for  having  abandoned 
them. 


CHAPTER  IX. 

THEORIES  AND  SYSTEMS.- 

GENERAL     CONSIDERATIONS. 

In  proportion  as  the  physical  science  of  man  was  cleared  up  by  the 
researches  in  experimental  anatomy  and  physiology,  or,  the  diagnosis  of 

*  The  words  them-y,  system,  and  doctrine,  have  been  many  times  already  placed 
before  the  eyes  of  my  readers ;  nevertheless,  there  is  nothing  more  vague  than 
the  various  acceptations  that  authors  attach  to  them — especially  the  first  two. 
If,  to  clear  up  this  uncertainty,  we  have  recourse  to  the  most  modern  and  best 
esteemed  lexicons,  we  find  nothing  in  them  satisfactory.  No  one  gives  a  rational 
explanation  of  the  synonymy  of  these  terms,  and  the  shades  of  difference  between 
them,  (a)  Some  of  the  more  recent  writers  have  attempted  to  introduce  the  fol- 
lowing distinction :  "  A  theory,"  say  they,  "  is  the  production  of  a  genius  who 
sees  nature  as  it  is  ;  a  system  is  a  product  of  the  imagination,  which  bends  every 
thing  in  nature  to  its  taste."  But  it  is  evident  that  such  a  definition  rests  on  an 
uncertain  and  arbitrary  base ;  for  each  author  and  his  partisans  being  inclined  to 
consider  their  opinions  the  only  true  ones,  will  attribute  to  those  of  their  adversa- 
ries such  qualifications  as  give  them  an  erroneous  character,  as  is  clearly  shown 
by  M.  Raige-Delorme,  in  the  Dictionary  of  Medicine,  in  21  volumes,  at  the  word 
Doctrine. 

M.  Bouillaud  complains  very  bitterly  of  the  want  of  accuracy  and  precision  in 
philosophical  terminology,  and  more  especially  of  the  ambiguity  of  the  words 

{a)  Consult,  on  this  subject,  Dictionaire  de  VAcademie. — Dictionalre  de  Laveaux. — Dictionaire 
de  M.  Napoleon  Landais.— Dictionaire  des  Sciences  Medicalos,  in  60  volumes. — Dictionaire  des 
Synonymcs,  by  Boinvilliers. 


CLINICS.  201 

diseases  became  more  perfect,  as  the  conquests  in  natural  history  multi- 
plied the  resources  of  therapeutics,  it  became  more  and  more  necessary 
to  classify  the  material  acquisitions  of  science,  in  a  methodical  order, 
that  could  be  recalled  easily  by  the  memory ;  and  to  unite  by  a  theory, 
more  or  less  reasonable,  the  multitude  of  old  and  new  facts,  that  made 
up  the  treasure  of  Medicine. 

A  great  number  of  philosophic  writers,  holding  different  views, 
attempted  this  difficult  enterprise ;  some,  in  fact,  endeavored  to  unite 
the  traditions  of  the  past  with  the  conquests  of  the  present,  without 
changing  at  all  the  fundamental  principles  of  the  accredited  doctrine,  and 
by  the  aid  only  of  a  few  modifications  of  details.  Others,  on  the  contrary, 
judging  these  principles  to  be  erroneous  or  insufficient,  aspired  to  nothing 
less  than  the  overthrow  of  the  ancient  edifice  of  science,  in  order  to 
reconstruct  it  on  new  foundations. 

If  the  historian  should  attempt  to  record  the  particular  opinions 
emitted,  on  each  of  the  phenomena  of  the  animal  economy,  he  would 
find  nearly  as  many  different  theories  as  there  exist  authors  in  Medi- 
cine ;  for  there  is  not  a  single  physician  who  has  not  modified,  in  some 
point,  by  his  own  experience,  the  doctrine  which  he  has  received  from 
his  masters.  But  if  regard  be  had  only  to  the  capital  differences — 
to  the  divergence  in  principles — the  theories  which  most  divided  physi- 
cians of  this  period  may  be  ranged  under  four  heads,  namely:  Dogma- 
tism, Empiricism,  Methodism,  and  Eclecticism  or  Syncretism. 

theory,  system,  doctrine,  etc. ;  but  he  has  not  remedied  it.  (6)  M.  Coutanceau  is 
the  only  one  in  my  knowledge,  who  has  given  a  clear  and  logical  definition  of  the 
theory  and  system.  A  theory,  he  says,  indicates  the  relation  of  facts  among 
themselves ;  it  marks  their  order  of  succession  and  dependence.  A  system  (in 
medicine)  is  a  general  theory  of  the  laws  and  mechanism  of  life,  by  means  of 
which  we  endeavor  to  reduce  to  a  small  number  of  principles,  sometimes  even, 
to  one  alone,  all  the  phenomena  of  health  and  disease,  (c) 

Though  M.  Coutanceau  has  limited  to  medicine  his  definition  of  system,  whilst 
his  definition  of  theory  is  applicable  to  all  sciences,  he  has  nevertheless  appre- 
ciated and  expressed,  more  happily  tlian  any  other  writer,  the  shade  of  difi"erence 
between  the  two  expressions,  and  the  similitude  which  unites  them,  in  saying  that 
a  system  is  a  general  theory.  Such  is  the  sense  which  we  have  ourselves  attached 
to  these  words,  when  we  would  make  a  distinction ;  thus  we  say,  the  theory  of 
inflammation  and  of  fever;  the  system  of  Hippocrates,  of  Themison  and  Stahl. 
Lastly,  the  word  doctrine  has  a  still  more  extended  signification ;  for  it  signifies 
all  that  one  believes  or  teaches,  on  any  matter  whatever.  It  embraces,  in  its 
scope,  theoretical  and  practical  notions,  systems,  facts,  and  hypotheses ;  it  is  what 
must  be  understood  by  the  following  expressions,  which  recur  so  often  in  medical 
language :  the  doctrine  of  Cos,  of  Montpelier,  of  Leyden,  etc. 

(6)  See  hi3  Essai  de  Pliilosophie  Mr;dicale,  Paris,  183C,  page  176,  note. 
(c)  See  Diet.  Med.,  in  21  vols.,  words  Theory,  System. 

13 


202  ANATOMICAL   PERIOD. 

ART.    I.     ON    DOGMATISM. 

We  know,  already,  the  principles  of  Dogmatism,  its  origin,  its  authors, 
and  its  most  illustrious  partisans.  We  know  that  this  doctrine,  taught 
in  the  school  of  Cos,  and  sustained  by  Plato  and  Aristotle,  had  reigned 
in  the  medical  world  for  several  centuries  before  the  school  of  Alexan- 
dria was  established.  The  earliest,  and  the  most  celebrated  professors 
of  that  school,  brought  up  in  the  tenets  of  Dogmatism,  made  few  changes 
in  it.  Herophilus  admitted  the  sentiments  of  Hippocrates,  and  Praxa- 
goras,  his  master,  on  the  effect  of  the  mingling  of  humors,  in  health  or 
disease,  and  followed  nearly  their  rules  in  the  practice.  Besides  great 
discoveries  in  anatomy,  he  made  many  experiments  with  medicines. 
which  he  termed  the  hands  of  the  gods  when  properly  employed,  but 
useless,  and  even  injurious  instruments,  if  a  practitioner  is  ignorant  of 
their  appropriate  use.''"' 

Erasistratus,  though  adopting  the  greater  part  of  the  Hippocratic 
dogmas,  thought  that  fever  and  inflammation  proceeded  from  the  pas- 
sage of  the  blood  from  the  veins  to  the  arteries.  According  to  him, 
these  last  vessels  contained,  naturally,  only  air,  or  spirits  ;  "  but,"  said 
he,  "  when  there  is  an  excess  in  the  veins,  extravasation  takes  place, 
into  the  arteries,  and  creates  all  the  inflammatory  and  febrile  symptoms." 
The  sanguineous  plethora  appeared  to  him  to  be  the  most  frequent  cause 
of  diseases  ;  nevertheless,  to  combat  it,  he  rarely  employed  bleeding. 

He  preferred  abstinence  or  fasting,  dieting,  mild  injections,  vomits, 
exercise,  and  baths.  He  was  not  very  partial  to  purgatives,  and  did 
not  believe,  with  Hippocrates,  that  certain  of  these  remedies  had  the 
property  of  eradicating  some  particular  humor,  exclusively.  He  said, 
that  the  thinnest,  and  most  subtile  humors,  were  first  carried  off"; 
then  the  more  tenacious  followed.  According  to  him,  the  mildest  pur- 
gatives produce  only  slight,  watery  evacuations  ;  those  which  are  a 
little  stronger,  carry  off"  the  bile  ;  and  the  strongest  of  all,  the  atrabile. 

But  of  all  the  sectators  of  Dogmatism,  the  most  fruitful,  the  most 
skillful,  and  the  most  powerful,  was  Claudius  Galen.  He  was  a  native 
of  Pergamos,  a  city  of  Asia-Minor,  celebrated  for  its  temple  dedicated 
to  Esculapius,  its  school  of  Medicine,  and  its  library  —  which  in  rich- 
ness was  only  second  to  that  of  Alexandria.  His  father  was  his  first 
master,  who  placed  him,  also,  under  professors  very  distinguished  in  all 
the  sciences.  The  young  Galen  profited  by  their  instructions,  with 
extraordinary  success.  He  was  already  in  a  state  to  dispute  with  the 
most  erudite,  on  grammar,  history,  mathematics,  and  philosophy,  when, 

'■  Galen,  De  Compos.  Medicam.  local.,  lib.  vi,  cap.  iii,  (Luler,  p.  322.) 


THEORIES   AND   SYSTEMS.  203 

on  the  express  advice  of  the  gods,  he  decided  to  study  Medicine.  He 
recounts  with  complacency,  how  this  counsel  was  twice  given  to  him  in 
a  dream,  by  Apollo,  and  that  he  could  not  resist  the  divine  will,  s« 
clearly  manifested.  But  his  numerous  and  learned  writings  justify 
much  better  his  medical  vocation,  than  all  these  mysterious  reminis- 
cences. 

He  undertook  several  voyages,  for  instruction,  and  visited,  among 
other  cities,  the  capital  of  Egypt,  where  he  remained  some  time.  On 
his  return  to  his  country,  he  was  charged  by  the  Pontiff,  to  dress  the 
wounded  in  tlie  circus,  which  furnished  him  an  opportunity  to  display 
his  anatomical  knowledge  and  surgical  skill.  Very  soon  afterward  he 
left  again  his  native  city,  to  go  and  exhibit  himself  in  a  much  grander 
theater.  He  went  to  Eome,  preceded  by  his  great  renown,  and  where  his 
easy  and  brilliant  elocution,  his  profound  and  varied  erudition,  and  prac- 
tical skill,  secured  him  the  esteem  of  the  highest  personages ;  but  his 
rapid  success,  his  boasting,  his  disdain  for  his  confreres,  which  he  took 
no  pains  to  disguise,  and  his  natural  jealousy,  raised  up  against  him  a 
crowd  of  enemies,  who  rendered  his  stay  at  Eome  very  disagreeable.  A 
conception  of  this  may  be  had,  by  the  following  picture,  which  he  draws  of 
the  physicians  of  that  capital,  in  his  work  on  Prenotions  •'  He  accuses 
them  of  base  jealousy,  and  stupid  ignorance,  and  pours  out  upon  them 
such  epithets  as  thieves,  and  poisoners,  and  closes  by  saying,  that  after 
having  unmasked  them,  he  would  shield  himself  from  their  hidden  and 
evil  designs,  by  abandoning  the  great  and  populous  city — where  a  man 
has  consideration  only  in  proportion  to  the  luxury  he  displays  ;  where 
a  shameless  charlatanism  usurps  the  confidence  of  a  stupid  and  frivolous 
public  —  to  seek  a  home  in  some  smaller  city,  where  the  citizens  are 
mutually  acquainted,  and  therefore  know  the  birth,  education,  fortune, 
and  private  life  of  each  other. 

He  left  Eome,  but  very  soon  returned,  on  the  invitation  of  the  emperors 
Marcus  Aurelius  and  Lucius  Verus.  He  had  also  the  confidence  of 
their  successors,  Commodus  and  Septimus  Severus.  It  is  supposed  that 
he  died  in  the  seventy-first  year  of  his  age,  toward  the  close  of  the 
second  century  of  the  Christian  era,  either  at  Eome  or  Pergamos,  or  on 
the  passage  from  one  city  to  the  other.  A  monk  has  imagined  that  he 
finished  his  days  during  a  pilgrimage  to  the  Holy  Land. 

Galen  asserts,  that  he  was  not  attached  to  any  of  the  sects  that 
divided  the  physicians  of  his  time.  He  treats  as  slaves  those  who  took 
the  title  of  Hippocratists,  Praxagoreans,  Herophilians,  etc. ;  but  he  is 
not  to  be  credited,  when  he  affects  to  hold  an  equal  balance  among  the 

-'  De  Proenotione  ad  Posthumum,  edition  of  Chartier,  Tom.  VIII,  page  836. 


204  ANATOMIC   PERIOD. 

various  doctrines.  It  is  probably  only  an  absence  of  mind,  very  pardon- 
able in  a  man  wbo  has  written  so  much  ;  or  an  oratorical  artifice,  to  show 
d"n  air  of  independence  and  impartiality.  His  predilection  in  favor  of 
the  doctrine  of  Hippocrates  is  well  marked:  he  explains,  comments  upon, 
and  amplifies  it  at  length ;  he  refutes  the  objections  of  its  adversaries, 
and  strives  to  give  it  the  ascendancy  over  all  others.  "  No  one,"  he 
says,  "  before  me,  has  given  the  true  method  of  treating  diseases.  Hip- 
pocrates, I  confess,  has  heretofore  shown  the  path,  but  as  he  was  the 
first  to  enter  it,  he  was  not  able  to  go  as  far  as  he  wished.  The  order 
he  adopted  is  bad ;  he  omits  certain  important  indications,  and  has  not 
made  all  the  distinctions  necessary.  Often,  he  is  obscure,  as  is  usually 
the  case  with  the  ancients,  when  they  attempt  to  be  concise.  He  says 
but  very  little  of  complicated  diseases  ;  in  a  word,  he  has  only  sketched 
what  another  was  to  complete ;  he  has  opened  the  path,  but  has  left  it 
for  a  successor  to  enlarge  and  make  it  plain."'-' 

This  short  quotation  shows  the  point  assumed  by  Galen,  and  how 
slightly  he  regards  the  labors  of  the  physicians,  who  lived  between 
Hippocrates  and  himself.  Let  us  now  see  how  he  has  acquitted  himself 
of  the  task  he  so  arrogantly  undertakes. 

There  are,  according  to  him,  three  sorts  of  principles  in  man,  viz., 
spirits,  humors,  and  solids,  which  he  also  named  parts. 

Among  the  solids,  some  are  simple,  or  similar ;  that  is  to  say,  if  they 
are  divided,  each  fraction  is  homogeneous  with  the  rest.  Such  are  the 
bones,  flesh,  nerves,  membranes,  etc.  These  structures  have,  in  vain, 
been  divided  into  as  many  fractions  as  were  desired,  but  there  always  re- 
main in  each,  pieces  of  bone,  flesh,  or  membrane,  similar  to  the  entire  bone, 
flesh,  or  membrane,  that  has  been  broken  up.  Other  parts  are  called 
organic,  or  compound,  as  the  arm,  leg.  head,  or  eye ;  because  they  exe- 
cute the  most  striking  and  perfect  acts,  and  because  they  are  formed  of 
several  similar  parts. 

There  are  some  simple  parts  that  take  their  origin  from  the  semen ; 
such  as  nerves,  membranes,  bones,  and  veins.  These  are  not  very  sus- 
ceptible to  corruption,  and  are  not  regenerated  after  they  have  been 
destroyed.  There  are  other  simple  parts  which  degenerate  easily,  and 
are  reproduced  with  the  same  facility.  They  are  those  that  come  from 
the  blood,  as  the  fleshes. f 

Galen  refutes,  with  Hippocrates,  and  by  the  same  arguments,  the 
opinion  of  those  philosophers  who  recognize  but  one  element ;  neither 
does  he  share  the  advice  of  those  who,  in  admitting  several  elements, 

■'  Method  Medencli.  lib.  ix,  cliap.  viii. 

•{•  De  Constitutione  Artis  Medicie.     Also,  De  semine. 


A 


THEORIES   AND   SYSTEMS.  205 

regard  the  corpuscles  as  incommunicable  in  their  essence.  When  the 
tissues  are  divided,  he  says,  both  pain  and  heat  are  excited ;  now,  both 
of  these  results  would  not  transpire  if  they  were  composed  of  one  ele- 
ment alone,  or  if  the  elements  that  enter  into  their  constitution  were 
unalterable.  Nothing  more  would  be  realized,  in  such  a  case,  than 
when  one  finger  is  separated  from  another,  which  excites  not  the 
slightest  pain  or  heat.  In  consequence  of  this  reasoning,  Galen  ranges 
himself  on  the  side  of  Hippocrates  and  Aristotle,  who  admitted,  as  we 
know,  four  elements  or  primordial  qualities,  heat,  cold,  dryness,  and 
moisture.  He  thought  that  all  the  changes  which  occur  in  the  body  are 
due  to  one  of  these  elements ;  but  he  regards  heat  as  the  most  active  of 
all,  and  cold  next  to  it.  The  natural  bodies,  he  says,  in  which  the 
primitive  qualities  show  themselves  in  the  highest  degree,  are  fire,  air, 
earth,  and  water.  These  are  called  elementary,  because  the  others  are 
derived  from  them.-' 

We  perceive,  therefore,  that  Galen  reproduces  and  amplifies  the  Hip- 
pocratic  Dogmatism.  What  follows  is  a  continuation  of  the  same  sub- 
ject ;  but  the  reader  who  is  cm  fait  in  the  doctrine  of  Cos,  will  discern, 
without  my  pointing  them  out,  expressly,  the  additions  and  pretended 
improvements  which  the  physician  of  Pergamos  makes  to  this  doctrine. 
I  proceed,  then,  without  interruption  to  exhibit  the  system  of  Galen. 

There  exists  between  the  elementary  or  similar  parts  of  the  human 
body,  four  simple  variations :  that  is  to  say,  one  part  may  be  hotter  than 
the  other,  or  colder,  or  dryer,  or  moister.  There  exists,  also,  or  may 
exist,  between  these  same  parts,  four  compound  variations,  namely,  one 
may  have  more  heat  and  dryness  than  another,  or  more  heat  and  mois- 
ture, etc.  The  exact  proportion  and  mixture  of  these  qualities  produce 
the  best  constitution,  or  perfect  health.  But  this  perfection  is  rather 
an  ideal  type  than  a  reality ;  the  most  healthy  men  are  always  a  little 
removed  from  it. 

Between  perfect  health  and  disease  there  are,  according  to  Galen, 
eight  kinds  of  temperaments  or  imperfect  mixtures,  compatible  with  the 
free  exercise  of  the  functions  of  life.  Four  of  these  elements  are  sim- 
ple, and  four  compound.  If  a  man  has  in  every  part  of  his  body,  or  in 
some  one  part,  an  excess  of  heat,  it  may  be  said  that  his  temperament 
is  simply  hot;  or  if  the  excess  be  in  moisture,  his  temperament  is 
humid,  and  so  on  for  the  rest.  But  if  there  exist  an  excess  of  heat  and 
moisture  at  the  same  time,  in  the  body  of  an  individual,  or  in  any  por- 
tion of  his  system,  then  that  individual  would  have  a  hot  and  moist  or 


°  De  Constitutione  Artis  Medicae  —  Introductio  sen  Medicus  —  De  Elementis  ex 
Hippocrate. 


206  ANATOMICAL   PERIOD. 

a  compound  temperament.     Disease,  says  Galen,  is  not  a  temperament, 
but  an  intemperament.'' 

After  this  somewhat  subtle  and  arbitrary  classification  of  tempera- 
ments, Galen  designates  the  signs  that  characterize  each  of  them. 
Here,  for  example,  are  those  that  indicate  a  cold  brain :  the  natural 
emunctories  of  this  Viscus,  viz.,  the  palate,  ears,  nose,  and  eyes  pour  out 
excretions  too  freely.  The  hair  is  straight,  red,  rather  stiff,  thin,  and 
poorly  nourished ;  it  grows  slowly.  Persons  in  this  condition  are  very 
sensible  to  refrigerant  influences,  and  very  subject  to  catarrhs  and  heavi- 
ness of  the  head.  The  skin  about  the  cranium  is  neither  hot  nor 
flushed.  The  veins  of  the  eyes  are  scarcely  visible :  in  short,  these 
persons  have  a  remarkable  propensity  to  sleep. f  Our  physiologist 
passes  in  review  in  this  manner  all  the  principal  organs  of  the  human 
body,  and  describes  the  signs  of  their  various  temperaments. 

Then  he  describes  the  temperaments  of  the  natural  humors  of  the 
body,  and  those  of  certain  substances  foreign  to  the  animal  economy. 
In  these  descriptions  we  still  see,  as  in  all  that  precedes  them,  the 
evident  traces  of  the  Hippocratic  Dogmatism.  Thus,  according  to  the 
opinions  of  the  physician  of  Pergamos,  the  blood,  air,  and  the  spring 
season  are  hot  and  humid;  the  yellow  bile,  summer,  and  fire  are  hot 
and  dry;  the  earth  and  autumn  are  dry  and  cold;  the  phlegm,  water, 
and  winter  are  cold  and  wet.  It  is  indispensable  that  the  humors  of 
the  body  be  reciprocally  transmutable — -just  as  are  all  the  primitive 
elements ;  for,  though  they  exist  in  all  parts  mingled  together,  and 
mutually  temper  each  other,  there  is  nevertheless  an  organ,  a  period  of 
life,  and  a  season  in  which  some  one  of  them  more  particularly  abounds. 
The  blood,  for  instance,  predominates  in  the  heart  among  the  adolescent 
and  in  the  spring ;  the  yellow  bile  in  the  liver,  in  middle  life  and  in 
summer. I 

Beside  the  structures  and  humors,  there  is,  also,  in  the  animal  econ- 
omy, a  third  principle,  which  is  called  spirits.  These  spirits  are  of 
three  kinds,  namely,  natural  spirits,  which  Galen  compares  to  a  subtile 
vapor  that  arises  from  the  venous  blood.  They  originate  in  the  liver, 
which  is  also  the  source  of  the  blood ;  thence  they  proceed  to  the  heart, 
where  they  mix  with  the  air  which  that  viscus  attracts  from  the  lungs, 
and  unite  with  it  to  form  the  vital  spirits.     These  last  are  thrust  by 

'■'  De  Constitutione  Artis  Medicce,  chap,  ix  ;  Ars  Medica,  cap.  iv ;  De  Tempera- 
mentis,  lib.  i,  chap,  vm ;  De  Optima  Nostri  Corporis  Constitutione ;  De  Sanita 
Tuenda. 

■j-  Ars  Medica,  cap.  vm  ;  De  Temperamentis,  lib.  i,  ii,  iii. 

I  De  Humoribus  Introductis  seu  Medicus,  cap.  xii ;  De  Placitis  Hippocratis  et 
Platonis. 


THEORIES   AND   SYSTEMS.  207 

the  arteries  into  all  parts  of  the  system,  but  chiefly  into  the  brain,  where 
they  are  converted  into  animal  spirits. 

The  spirits  are  the  instruments  or  servants  of  the  soul,  which  governs 
the  animal  economy. 

Galen  thought,  with  Plato  and  Aristotle,  that  the  human  soul  is  com- 
posed of  three  faculties,  or,  rather,  of  three  parts :  the  vegetative,  which 
resides  in  the  liver ;  the  irascible,  which  has  its  seat  in  the  heart ;  and 
the  rational,  which  dwells  in  the  brain." 

Each  faculty  of  the  soul  has  in  its  service,  according  to  Galen,  inde- 
pendently of  the  spirits,  a  certain  number  of  secondary  faculties.  Thus, 
the  vegetative  soul  held  in  its  department,  the  generative,  growing,  and 
nutritive  faculties.  These  secondary  faculties,  in  their  turn,  fulfilled 
their  functions,  aided  by  faculties  of  a  third  order.  The  nutritive,  for 
example,  which  has  its  principal  locality  in  the  stomach,  is  assisted  by 
attractive,  retentive,  assimilative,  and  expulsive  faculties. f 

Aided  by  this  hierarchy  of  souls,  spirits,  and  faculties,  Galen  and  his 
sectators  had  no  difficulty  in  giving  an  account  of  all  the  functions  of  the 
animal  economy.  If  the  question  was  asked  of  one  of  them,  how  nutrition 
is  performed,  the  answer  was :  nutrition  is  a  natural  function,  to  which 
four  faculties  concur,  namely :  the  attractive,  which  draws  the  food ;  the 
retentive,  which  keeps  it  for  a  sufficient  time,  for  coction  to  take  place ; 
the  assimilative,  which  transforms  it  into  particles  analogous  to  the  sub- 
stance of  our  bodies ;  the  expulsive,  which  eliminates  their  excrementi- 
tial  residuums.  When,  I  say,  the  candidate  had  made  this  response,  pro- 
fessors and  assistants  must  show  themselves  equally  satisfied,  for  he  had 
explained,  according  to  the  language  of  the  times,  what  was  supposed  to 
constitute  the  essence  of  the  nutritive  function. 

Pathology  ofi'ers  us  the  same  assemblage  of  imaginary  or  abstract 
entities,  to  which  attributes  were  ascribed,  as  to  real  beings.  We  find 
accounts  of  diseases  that  had  their  seats  in  the  solids,  humors,  and 
spirits. 

Diseases  of  the  solids  were  divided  into  three  orders :  the  first  com- 
prises afi'ections  of  similar  parts,  and  also  named  distempers.  There 
are  two  species  of  distempers,  namely:  the  simple  distemper,  which 
proceeds  from  the  excess  of  a  single  element,  whether  heat,  cold,  dryness, 
or  moisture ;  the  double,  or  complex  distemper,  which  results  from  an 
excess  of  two  of  these  elements  at  the  same  time,  as  an  excess  of  heat 
and  dryness,  or  an  excess  of  heat  and  moisture,  etc.  The  second  order 
comprises  aflfections  of  organic  parts,  which  consist  in  irregularities  of 

'  De  Facultatibus  Naturalibus,  lib.  i.,  n.,  in, 
t  De  Facultatibus  Naturalibus. 


208  ANATOMICAL   PERIOD. 

conformation,  errors  in  number,  size,  or  situation.  Finally,  the  third 
order,  which  is  common  to  similar  parts,  and  organic  parts.  It  includes 
all  the  accidents  connected  with  the  solution  of  continuity.  Galen  dis- 
tinguishes, also,  among  the  diseases  of  the  solids,  various  complications, 
which  constitute  so  many  new  species.'-'^ 

The  essence  of  fever  consists  in  an  unnatural  heat,  which  sometimes 
is  kindled  in  the  tissue,  even,  of  the  heart ;  again,  in  the  humors  of  this 
viscus ;  and,  lastly,  occasionally  in  the  spirits.  The  latter  are  most 
promptly  inflamed ;  next,  the  humors ;  lastly,  the  solids.  Fevers  of 
the  shortest  duration  have  their  seat  in  the  first;  those  of  medium 
duration,  in  the  second ;  and  those  that  are  longest  continued,  in  the 
parenchyma.! 

Ardent  fevers  degenerate  into  the  hectic,  or  consumptive,  in  two  ways ; 
first,  when  they  are  prolonged  to  such  an  extent  as  to  consume  all  the 
humidity  of  the  heart,  and  then  seize  upon  the  tissue,  even,  of  the 
organ ;  second,  when  they  invade  the  substance  of  the  heart,  before  all 
its  humidity  is  consumed.  Hectic  fevers  are  recognized  by  the  tem- 
perature of  the  body  of  the  arteries,  which  is  more  elevated  than  the  con- 
tiguous parts.  This  diiference  is  especially  marked,  at  the  moment  of 
the  diastole  of  the  artery.  J 

Among  the  fevers  which  proceed  from  the  humors,  Galen  distinguishes 
three  orders,  viz :  the  continent,  continued,  and  intermittent.  Each  of 
these  orders  he  divided  into  many  species.  Of  intermittent  fevers,  the 
most  common  are  the  quotidian,  the  tertian,  and  the  quartan.  The 
first  is  produced  by  the  phlegm ;  the  second,  by  the  yellow  bile ;  the 
third,  by  the  atrabile.  Galen  admits,  besides  these,  many  other  species 
of  fevers,  both  simple  and  compound. 

In  regard  to  the  progress  of  these  febrile  affections,  our  pathologist 
recognizes,  with  Hippocrates,  four  periods,  which  he  names  invasion, 
augmentation,  stasis,  and  decline.  He  compares  these  periods  to  the 
four  ages  of  man,  in  the  following  order :  the  first  age,  or  that  of  gene- 
ration ;  the  second,  or  that  of  growth ;  the  third,  or  that  of  force  and 
vigor ;  the  fourth,  or  age  of  decline.  When  the  patient  succumbs,  it  is 
always  in  one  of  the  first  three  phases ;  never  in  the  last.[| 

In  other  respects,  in  regard  to  coction,  crises,  and  critical  days,  our 
author  concurs  in  the  pure  doctrines  of  Cos. 

He  divides  the  action  of  remedies  into  primitive,  and  consecutive. 
The  primitive  action  depends  on  one  or  two  qualities,  which  exist  in  the 

•'  De  Morborum  DifFerentiis  liber. — ^De  Morborum  Causis,  liber. 
■j-De  Differentiis  Februm,  lib.  i,  cap.  i. 

I  De  Differentiis  Februm,  lib  i,  cap.  x.,  xiii. 

II  De  Morborum  Temporibus,  etc.,  lib.  ii. 


THEORIES   AND   SYSTEMS.  209 

medicine.  Thus,  one  substance  will  excite  heat  or  warmth,  because  the 
element  of  fire  predominates  in  it ;  another  is  cooling,  because  it  has  the 
cold  element  in  excess.  There  are  also  substances  that  produce  heat 
and  dryness  at  the  same  time ;  others  which  excite  heat  and  moisture. 
Among  therapeutic  agents  endowed  with  the  same  property,  for  example, 
that  of  heating,  some  have  it  in.  an  eminent,  and  others  in  an  inferior 
degree.  Thus,  bitter  substances  are  extremely  heating ;  the  sweet  are 
only  moderately  so,  their  heat  but  little  surpassing  ours.  The  saline 
taste  proceeds  from  the  excess  of  the  igneous  and  terrestrial  principle.'"' 
There  are  substances  which  produce  their  effects  immediately  ;  for  exam- 
ple, fire  heats  at  once  ;  and  ice  cools  in  like  manner.  The  effect  of  others 
is  not  so  prompt,  such  as  the  anthemis  pyrethrum  and  castor,  which  pro- 
duce a  sensation  of  heat  only  after  some  time  has  elapsed ;  and  hyosci- 
amus  and  mandragore  cool,  also,  slowly.  A  thing  may  be  said  to  possess 
a  quality,  naturally,  or  accidentally,  accordingly  as  it  is  a  natural  or 
accessory  attribute.  Water,  for  example,  which  is  naturally  cold,  may 
become  hot,  accidentally,  but  its  acquired  heat  is  not  long  retained, 
while  its  natural  coldness  persists,  habitually.  After  other  distinctions, 
still  more  subtile,  on  the  various  ways  in  which  we  may  observe  the 
primitive  effects  of  medicaments,  Galen  traces  the  rules  to  be  followed 
in  order  to  recognize  their  effects ;  he  indicates  the  precautions  to  be 
observed,  so  as  not  to  be  deceived  by  false  appearances.  Passing  then 
from  precept  to  example,  he  demonstrates  by  a  series  of  experiments  and 
arguments,  that  water  has  a  cold  and  humid  temperament ;  vinegar  a 
cold  temperament,  with  a  certain  mixture  of  heat  proceeding  from  its 
acridness.f 

The  consecutive  action  of  medicines  is  so  called,  because  it  is  manifest 
after  the  primitive  effect,  and  as  a  consequence  of  it.  This  action  is 
very  varied  ;  thus,  there  are  medicines  that  open  the  pores,  others  which 
close  them  ;  some  harden,  others  soften  the  tissues  ;  some  purge  the  hu- 
mors, others  alter  them  ;  some  hasten  their  maturation  and  the  formation 
of  pus ;  others  give  relief  to  pain,  etc.  There  are,  also,  remedies  whose 
consecutive  action  is  especially  related  to  certain  organs,  or  certain  func- 
tions ;  such  as  diuretics,  vomits,  drastics,  emmenagogues,  etc.  Galen 
sought  to  establish  the  connection  which  exists  between  the  primitive 
and  secondary  action  of  remedies ;  for  example,  he  supposed,  that  reme- 
dies which  harden  the  tissues,  are  of  a  cold  and  moist  temperament ; 
those  which  increase  the  flow  of  urine,  are  hot  and  dry ;  and  those  that 
increase  the  secretion  of  milk  and  semen,  are  moderately  hot  and  humid.| 

**De  Simplicium  Medicamentorum,  Temperamentis  Facultatibus,  lib.  i,  ir,  ra,  iv. 
t  Ibid.,  lib.  I,  n,  in,  it.  |  Ibid,,  lib.  v. 


210  ANATOMICAL   PERIOD. 

As  to  the  principles  which  should  guide  the  practitioner  in  the  choice 
of  therapeutic  means  applicable  to  each  disease,  the  physician  of  Per- 
gamos  adopted  fully  the  axiom  proclaimed  by  the  school  of  Cos,  which 
says,  that  diseases  are  cured  by  their  contraries.  Consequently,  all 
researches  and  pathological  dissertations  aimed  to  penetrate  the  essence 
of  diseases,  to  make  it  evident,  and  distinct  from  all  accessory  accidents  ; 
in  short  to  apply  to  this  essence  a  treatment  whose  action  would  be 
diametrically  opposite  to  its  mode  of  existence.  Now,  he  considered 
this  essence  to  be,  sometimes,  the  excess  of  one  or  two  elementary  quali- 
ties of  the  diseased  part ;  again,  the  re-action  of  the  vital  principle,  the 
efl&cient  and  primary  cause  of  all  the  symptoms.  In  this  respect  his 
doctrine  is  confounded  with  the  Dogmatists ;  it  is  nothing  else  than  Dog- 
matism itself,  amplified,  explained,  and  pushed  to  its  last  consequences. 
Occasionally,  however,  he  had  regard  to  the  constriction  and  relaxation 
of  the  pores,  which  approaches  the  views  of  the  Methodists.  Finally,  he 
professes,  in  many  passages,  a  great  consideration  for  the  pure  concourse 
of  symptoms  and  experience ;  fundamental  principles,  which  the  Empi- 
rists  placed  above  every  thing.  Notwithstanding  these  rare  and  slight 
digressions,  Galen  has  been,  and  must  be  regarded  as  one  of  the  pillars 
of  the  Hippocratic  Dogmatism, 

Though  he  has  written  a  great  number  of  treatises  on  pathology  and 
therapeutics,  it  would  be  difficult,  if  not  to  say  impossible,  to  treat  a 
single  disease  by  his  directions,  so  bad  is  the  method  he  has  adopted, 
and  so  defective  was  his  manner  of  studying  each  case.  I  except,  always, 
from  this  proscription,  the  last  four  books  of  the  treatise  on  Local  Affec- 
tions {de  Locis  Affectis) ,  where  he  gives  excellent  counsel  how  to  ascer- 
tain the  anatomical  seat  of  diseases,  particularly  of  a  mental  and  nervous 
character.  This  treatise,  joined  to  his  writings  on  anatomy  and  physi- 
ology, of  which  notice  has  already  been  taken,  constitute  for  the  physician 
of  Pergamos  imperishable  titles  of  glory,  and  justify  and  excuse  the 
infatuation  of  which  he  was  the  object  during  more  than  twelve  cen- 
turies. 

In  an  historical  sense,  this  encyclopedic  writer  has  rendered  immense 
services  ;  for  he  has  preserved  the  opinions  of  a  great  number  of  physi- 
cians whose  writings  have  perished,  and  especially  of  the  chiefs  of  the 
sects.  Thanks  to  him,  we  are  able  to  raise  a  corner  of  the  veil  that 
covers  the  great  contests  between  the  Dogmatists,  Empirics,  and  Meth- 
odists. If  the  numerous  works  he  has  published  are  not  now  a  trea- 
sure, easy  for  the  practitioner  to  explore,  they  are  an  arsenal  from  which 
the  erudite,  and  the  dialectician,  may  draw  arguments,  on  all  kinds  of 
medical  questions.  Now,  we  approach  an  epoch  in  "Which  physicians 
showed  themselves  more  anxious  to  shine  by  the  subtilties  of  dialectics, 


1 


THEOKIES   AND   SYSTEMS.  211 

and  the  glitter  of  a  vain  erudition,  than  by  the  wisdom  of  their  prac- 
tice ;  so  much  so,  that  the  defects,  even  of  this  author,  shall  contribute 
yet,  to  maintain  in  his  hands  the  scepter  of  Medicine  ;  because,  for 
erudition,  subtility  of  reasoning,  and  universal  knowledge,  he  was 
second  only  to  Aristotle,  and  excelled  even  him,  in  elegance,  purity,  and 
strength  of  style."-' 

ART.    II.     ON    EMPIRICISM. 

The  epoch  in  which  the  school  at  Alexandria  was  founded,  was,  as 
we  have  seen,  one  of  the  most  brilliant  in  the  history  of  the  human 
mind.  The  love  of  letters,  art,  and  philosophy,  generally  diffused 
throughout  Greece,  had  endowed  her  with  chefs  (Tceuvre  of  every  kind. 
The  companions  of  Alexander  had  carried  the  lights  of  her  young  and 
vigorous  civilization  to  the  center  of  Asia,  the  first  cradle  of  a  decrepid 
civilization.  In  short,  the  radiant  and  communicative  science  of  the 
Greeks,  eclipsed,  on  the  shores  of  the  Nile,  the  pale  and  shadowy  rays 
of  antique  Egyptian  wisdom.  "While  the  successors  of  Plato  and  Aris- 
totle continued  to  teach  the  doctrines  of  their  great  masters,  other  philo- 
sophers elevated  rival  schools,  and  strove  to  propagate  diverse  views. 
Epicurus  revived  and  embellished  the  system  of  Leucippus  and  Demo- 
critus,  on  atoms,  vacuum,  and  perpetual  motion.  Pyrrho  developed  the 
maxims  of  Parmenides  and  Zeno,  on  the  uncertainty  of  our  knowledge 
and  judgment.  He  founded  the  sect  of  Skeptics,  or  Zatetics,  who  have 
been  styled  the  indifferent,  in  matters  of  science,  as  the  Epicurians  were 
indifi"erent  in  mattei'S  of  morals.  On  the  other  hand,  Euclid  invented 
the  useless  art  of  embroiling  all  questions,  and  silencing  his  antago- 
nists, by  captious  and  odd  arguments.  His  sect,  which  was  named  con- 
tentious, sought  victories  only  in  public  debates,  at  that  time  very  much 
in  fashion  ;  and  they  put  in  vogue  a  prating  and  cavilling  dialectic, 
which  gradually  infected  the  other  schools. 

Medicine,  as  usual,  followed  in  the  track  of  philosophy,  and  was 
divided  into  several  opposing  camps.  Herophilus  and  Erasistratus, 
though  dissenting  from  some  of  the  points  of  the  Hippocratic  doctrine, 
respected  it  as  a  whole  ;  but  their  disciples,  Philinus  of  Cos,  Scrapie 
of  Alexandria,  and  others,  did  not  maintain  the  same  veneration  for 
it ;  they  attacked  even  the  principles  of  that  doctrine,  and  asserted 
that  all  which  it  affirms  touching  the  elements,  and  elementary  quali- 
ties, cardinal  humors,  coction,  crisis  and  critical  days,  the  occult,  or 

''  It  is  said  that  he  composed  more  than  five  hundred  volumes  on  Medicine,  and 
nearly  half  that  number  on  other  subjects.  But  it  must  be  observed,  that  among 
these  volumes  there  are  counted  many  little  manuscripts  of  a  few  pages  only. 


212  ANATOMICAL   PERIOD. 

proximate  causes,  and  the  essence  of  disease,  was  altogether  false,  or 
hypothetical.  They  rejected,  as  doubtful,  hazardous,  and  useless,  the 
famous  therapeutic  axiom  that  forms  the  basis  of  Dogmatism,  (diseases 
must  be  cured  by  their  contraries)  and  dared  to  reconstruct  the  Art  on 
new  foundations. 

This  medical  reform,  or  rather  revolution,  made  rapid  progress,  and 
the  names  of  a  number  of  physicians  of  high  standing,  are  cited  as 
supporting  it ;  but  the  most  celebrated,  after  the  two  coryphei,  whom 
we  have  named,  was  Heraclidus  of  Tarentum,  who  lived  cotemporary 
with  them,  or  a  few  years  later.  The  Methodist,  Coelius  Aurelianus, 
who,  following  the  expression  of  the  historian,  Daniel  Leclerc,  was  accus- 
tomed to  maltreat  the  physicians  of  other  sects,  speaks  of  Heraclidus, 
only  in  most  honorable  terms,  giving  him  the  epithets  of  noble  and 
famous  ;  calling  him  the  last,  and  the  most  estimable  of  the  Empirics.'-- 
Galen's  opinion  in  relation  to  him  is  nearly  the  same :  "  Heraclidus 
never  speaks  contrary  to  truth  to  defend  the  interests  of  his  sect — he 
announces  only  his  own  experience  ;  and  he  practiced  Medicine  as  well 
as  any  other  physician  of  the  time.f 

The  Empirics  composed  a  great  number  of  books,  which  are  lost.  It 
is  only  from  the  reports  of  writers  of  other  sects,  that  we  are  acquainted 
with  their  doctrines.  It  is  probable,  therefore,  that  they  have  not  been 
exhibited  in  the  most  favorable  light.  The  Empirics  go  back  to  the 
infancy  of  the  Art ;  they  recount  how  the  first  sick  were  treated,  and 
they  deduce  from  this  the  rules  for  the  perfection  of  medical  science. 

The  following  argument  of  theirs  is  copied  from  Celsus:  "  Among  the 
sick,  who,  in  the  commencement,  were  without  physicians,  some,  tor- 
mented by  hunger,  could  eat  from  the  first  days  of  their  illness ;  others. 
on  the  contrary,  disgusted  with  food,  could  eat  nothing,  and  recovered 
much  sooner  than  the  former.  Again,  some  ate,  even  during  a  fever ; 
others,  a  little  in  advance  of  its  accession ;  others  again,  after  it  had 
ceased ;  and  these  did  better  than  the  first  or  second.  Also,  those  who 
had  eaten  largely  at  the  beginning  of  their  disease,  were  in  a  much  more 
dangerous  condition  than  those  who  had  eaten  but  little.  As  these 
things  occurred  every  day,  attentive  persons  soon  observed  what  was 
best  suited  to  the  sick,  and  thereafter  prescribed  it.  Thus  medicine 
originated,  which,  from  the  essays  that  have  been  made,  sometimes  to 
the  advantage,  and  again  to  the  detriment,  of  the  sick,  has  been  the 
means  of  establishing  a  judgment  between  what  was  good,  and  what 

''  Acutorum,  lib.  i,  cap.  xvii.     Ibid.,  lib.  ii,  cap.  ix. 

f  Galen,  in  lib.  Hippocr.  des  Articcul.  Comment.  3.  Ibid.,  De  Composit.  Medical., 
per  genera,  lib.  iv,  cap.  vn. 


THEORIES    AND    SYSTEMS.  213 

was  evil.  It  was  only  then,  after  men  had  found  remedies,  that  they 
commenced  to  reason  on  the  manner  of  employing  them."  "  If,  now,  we 
compare  this  passage  with  those  taken  from  the  work  on  Ancient  Medi- 
cine, it  will  be  seen  that,  between  them,  there  is  perfect  conformity ;  but 
I  shall  have  occasion,  hereafter,  to  show  other  analogies  between  the 
doctrines  of  the  Hippocratic  works  and  the  system  of  the  Empirics. 

They  ranged  under  three  heads  the  method  of  acquisition  adapted  to 
Medicine :  first  was  personal  observation  on  autopsy ;  second,  the  study 
of  the  observations  collected  by  others — or  history ;  third,  the  induc- 
tions drawn  from  autopsy  and  history,  which  would  serve  to  discover 
things,  for  the  moment  concealed,  but  which  had  been  before  observed. 
The  last  method  was  termed  epilogism,  or,  in  other  words,  consecutive 
reasoning,  to  indicate  that  it  was  deduced  from  anterior  observations ; 
at  other  times,  it  was  called  analogism,  because  it  rested  on  a  similarity 
of  features.  These  three  sources  of  medical  instruction  :  autopsy,  his- 
tory and  epilogism,  formed  the  base,  or  what  was  termed  the  tripod  of 
Empiricism. 

AUTOPSY. 

The  Empirics  realized  fully  the  maxim  of  Hippocrates,  "experience  is 
deceptive  ;''  for  they  took  the  most  minute  precaution,  to  avoid  the  causes 
of  error  to  which  this  mode  of  acquisition  is  subject ;  though  it  is  the  first 
of  all,  and  the  true  foundation  of  the  Art.  They  thought,  for  example, 
that  a  disease  should  be  studied  a  great  number  of  times,  from  its 
accession  to  its  end  ;  in  a  simple,  and  in  a  complicate  state ;  in  indi- 
viduals of  different  temperaments,  ages,  and  sexes ;  and  the  knowledge 
attained,  of  what  conditions  favored  or  prevented  its  development,  etc., 
before  any  one  could  pretend  to  have  made  its  autopsy.  They  thought, 
also,  that  the  same  treatment  should  have  been  employed  a  great  number 
of  times,  in  the  same  disease,  and  under  different  circumstances,  before 
it  could  be  affirmed  that  it  would  be  efficacious  in  similar  cases. 

They  did  not  confound  symptoms  with  the  disease :  they  called  a  symp- 
tom an  isolated  phenomenon,  or  separate  consideration,  for  example : 
pain,  swelling,  redness,  cough,  and  difficult  respiration.  They  gave  the 
name  disease  to  an  assemblage  of  morbid  phenomena,  or,  in  other  terms, 
to  a  concourse  of  pathological  occurrences,  which  were  not  fortuitous, 
but  which  were  nearly  always  developed  in  the  same  form. 

Though  they  banished  from  their  pathology  the  research  of  what  the 
Dogmatists  named  essential,  or  consecutive  phenomena,  they  believed, 
nevertheless,  that  all  the  symptoms  were  not  of  equal  value.  They 
estimated   the   importance  of  a  pathological  phenomenon,  not  on  its 

*Celsus,  Trad,  de  Ninnin,  liv.  i,  chap  i. 


214  ANATOMICAL   PERIOD. 

pretended  essence,  wliicli  nothing,  they  said,  revealed,  but  on  the  mani- 
fest or  sensible  circumstances,  which  every  one  could  appreciate.  Thus,  a 
symptom  that  persisted  throughout  a  disease,  appeared  to  them  to  merit 
more  attention  than  one  whose  duration  was  much  shorter.  A  symptom 
related  to  the  functions  of  an  organ  essential  to  life,  or  which  announced 
a  grave  alteration  of  an  essential  organ,  was,  in  their  eyes,  more  serious 
than  one  which  involved  a  secondary  function,  or  indicated  a  superficial 
derangement. 

But,  however  grave  a  symptom,  they  were  not  willing  to  accord  to  it 
an  exclusive  consideration  ;  they  directed  their  attention  to  the  general 
state  of  the  patient,  or  the  concourse  of  symptoms.  Thus,  while  some 
physicians  attached  an  exaggerated  importance  to  the  character  of  the 
pulse,  urine,  or  other  dejections,  or  to  the  state  of  the  skin,  etc.,  for  the 
diagnosis  of  certain  diseases,  they  asserted  that,  as  far  as  possible,  no 
circumstance  should  be  neglected,  and  an  exploration  be  made,  in  every 
case,  not  only  of  the  organ  or  function  specially  affected,  but  also  of  all 
the  functions  and  organs,  or  at  least  the  principal  ones.  They  taught, 
also,  that  an  observation  should  be  made  of  the  accession  and  disappear- 
ance of  the  different  symptoms,  their  order,  course,  and,  in  short,  of  all 
their  relations  to  age,  sex,  habit,  complexion,  climate,  season,  etc. 

An  individual  who  had  observed,  frequently,  the  same  disease  from  its 
origin  to  its  close,  and  who  preserved  a  faithful  memory  of  its  symptoms, 
course,  and  most  ordinary  complications,  and  the  means  to  combat  them, 
possessed  a  theorem.  Any  one,  then,  who  had  thus  stored  in  his  mem- 
ory a  considerable  number  of  theorems,  possessed  experience  or  practical 
skill.  Thus,  autopsy,  or  clinical  observation  often  repeated,  established  a 
theorem,  and  the  reunion  of  a  number  of  theorems  constituted  experience. 

An  Empirical  theorem,  then,  was  nothing  else  than  an  exact  tableau 
of  all  the  known  phenomena  of  a  disease,  arranged  according  to  their 
importance  and  accustomed  order,  with  the  specification  of  their  varie- 
ties, and  of  the  appropriate  treatment,  either  separately  or  conjointly 
considered.  Each  theorem,  or  each  morbid  concourse,  in  Empiricism, 
was  designated  by  a  particular  name,  which  was  the  symbol  or  abridged 
expression  of  all  the  phenomena  which  made  up  the  theorem.  This 
name  was  derived,  sometimes,  from  the  part  principally  affected ;  thus, 
the  word  pneumonia  designated  a  concourse  of  symptoms,  whose  prin- 
cipal seat  was  the  lung ;  gastritis,  a  collection  of  symptoms,  relatino' 
principally  to  the  stomach ;  thus  avoiding  all  prejudice  as  to  the  nature 
of  the  symptoms,  and  the  cause  of  the  disease.  Sometimes,  the  name 
of  the  theorem,  or  morbid  assemblage,  was  derived  from  a  dominant 
symptom,  as  icterus,  mania ;  again,  from  the  resemblance  to  a  forei^^n 
object,  as  cancer,  elephantiasis,  etc. 


THEORIES   AND   SYSTEMS.  215 

The  Empirics,  we  thus  observe,  attached  but  a  secondary  importance 
to  the  name  of  a  disease,  for  that  did  not  indicate  to  them  its  essence, 
but  only  an  assemblage  of  morbid  symptoms.  The  essential  matter, 
with  them,  was,  that  each  concourse  be  traced  with  great  exactness, 
following,  at  first,  its  habitual  march,  then  its  irregularities  and 
complications. 

HISTORY. 

If  it  were  necessary  for  a  man  to  have  seen,  with  his  own  eyes,  most 
diseases,  with  all  their  varieties  and  almost  infinite  shades  of  difference, 
and  to  have  directed  the  remedies  employed  in  each  case,  and  to  keep 
faithfully  in  his  mind,  or  in  his  note  book,  the  account  of  all  these  mat- 
ters, he  must  have  reached  a  very  advanced  age  before  commencing  the 
practice  of  Medicine.  Few  men  could  have  been  found,  endowed  with 
patience,  sagacity,  and  memory  sufficient  to  finish  so  long  and  complicated 
an  undertaking.  Moreover,  the  experience  of  preceding  generations,  and 
thatof  our  cotemporaries,  would  be  almost  lost  to  us.  The  scientific  edi- 
fice of  jNIedicine,  in  place  of  being  extended  and  perfected  from  age  to  age, 
would  have  remained  stationary,  or  made  but  little  progress.  To  supply 
the  insufficiency  of  autopsy,  the  Empirics  had  recourse  to  historj^  that 
is  to  say,  to  clinical  relations  and  theorems,  committed  to  writing.  By 
the  aid  of  history,  we  participate  in  the  experience  of  all  other  men ; 
we  correct  our  own  observations  ;  we  are  able,  in  a  word,  in  a  few  years, 
to  acquire  more  knowledge  and  practical  skill  than  if  we  had  passed  all 
our  lives  in  collecting  notes  at  the  bedside. 

But  to  be  able  to  appreciate  the  value  of  this  source  of  instruction, 
we  must  know  how  to  make  a  judicious  use  of  it,  and  besides,  must 
only  confide  in  such  histories  as  present  sufficient  characteristics  of 
truth,  some  of  which  we  will  mention.  1 .  The  reputation  of  an  author 
is  an  essential  thing  to  consider.  Faith  is  much  more  readily  given  to 
the  recitals  of  a  man  like  Hippocrates,  who  has  the  reputation  of  an 
attentive  observer  and  truthful  writer,  to  whatever  sect  he  may  belong, 
than  to  the  narration  of  one  like  Andrews,  who  has  the  character  of 
being  an  inexact  'observer  and  an  insincere  writer.  2.  When  several 
histories,  of  different  epochs  and  countries,  recount  the  same  fact,  with 
analogous  circumstances,  it  ■  is  a  powerful  motive  to  confidence.  3.  A 
still  surer  guarantee  of  the  correctness  of  a  history  is,  that  it  accords 
with  our  own  observations.  It  is  necessaiy,  then,  before  receiving  the 
statements  of  a  writer,  to  submit  his  narration  to  a  critical  and  severe 
examination,  and  to  accept  it  only  in  proportion  to  the  degree  of  certainty 
it  presents.  Thus  illuminated,  history  becomes  a  sure  guide,  and  an 
extremely  useful  repertory  for  a  practitioner. 


216  ANATOMICAL  PERIOD. 


EPILOGISM   on  ANAX0GI8M. 


It  may  happen,  that  a  new  disease  is  presented  to  the  practitioner, 
which  has  not  before  been  described.  In  that  case,  neither  autopsy  nor 
history  can  offer  examples  as  a  guide.  It  may  happen,  also,  that  in 
treating  a  well-known  affection,  the  ordinary  remedies  indicated  are  not 
at  our  disposal;  here,  again,  history  and  autopsy  do  not  aid  us.  In 
both  these  cases,  one  is  obliged  to  have  recourse  to  reason,  and  be 
guided  by  analogy.  For  example,  a  physician  has  a  case  not  before 
seen,  nor  described  by  authors.  Search,  say  the  Empirics,  among  the 
historical  relations,  or  in  your  own  experience,  what  there  is  that 
approaches  nearest  to  the  present  disease,  then  treat  it  with  those  reme- 
dies which  have  succeeded  with  the  former.  Thus,  the  treatment  which 
has  been  employed  successfully  in  erysipelas,  may  be  tried  in  certain 
skin  affections  which  strongly  resemble  that  disease.  So,  also,  a  rem- 
edy which  had  cured  a  rheumatism  of  the  leg,  would  very  probably 
cure  it  in  the  arm.  If  it  is  desirable  to  replace  a  remedy  whose  efficacy 
is  known,  but  which  is  not  to  be  had,  by  an  equivalent  remedy,  seek,  say 
they,  among  the  medicines  at  your  disposal,  that  which  is  most  similar 
to  the  one  you  lack.  Thus,  you  may  substitute  the  juice  of  the  per- 
simmon for  that  of  the  quince,  on  account  of  the  astringent  taste  which 
is  common  to  both  of  these  fruits,  in  the  treatment  of  a  diarrhea,  the 
result  of  mei'e  relaxation  ;  and  a  decoction  of  flaxseed  may  well  replace, 
in  certain  eases,  that  of  the  root  of  the  althea. 

To  illustrate  epilogism  or  analogism  still  further,  suppose  a  patient 
is  attacked  with  pain  in  the  hypogastric  region,  which  is  sometimes  very 
acute,  again  less  so ;  returning  irregularly,  and  then  sometimes  entirely 
disappearing.  If  these  pains  are  increased  by  walking,  and  especially 
by  riding  on  horseback;  if  the  emission  of  urine  is  occasionally  inter- 
rupted suddenly,  to  commence  again  after  an  irregular  interval ;  if  a 
metallic  sound  introduced  through  the  urethra  into  the  bladder,  comes 
in  contact  with  a  body  that  creates  a  sensation  of  rubbing  against  a 
rough  and  solid  substance,  this  concourse  of  circumstances  would  autho- 
rize the  physician  to  think  that  a  vesicular  calculus  is  the  probable 
cause  of  these  symptoms.  Likewise,  if  the  cranium  of  an  individual 
who  has  accidentally  lost  his  reason,  presents  cicatrices,  and  a  depi'ession 
of  bone,  it  would  be  permitted  to  conjecture  that  a  wound  of  the  head 
is  the  cause  of  this  mania.  Finally,  if  an  individual  has  been  bitten 
by  a  strange  dog,  though  the  wound  may  present  nothing  peculiar  in  its 
character,  it  would  be  prudent  to  treat  it  as  an  envenomed  wound,  because 
observation  teaches  that  the  bite  of  a  mad  dog  resembles  entirely  that 
of  any  other  dog,  and  when  there  is  doubt,  it  is  best  to  take  the  surest 
method  for  the  prevention  of  hydrophobia. 


THEORIES   AND   SYSTEMS.  217 


DEFINITIONS   OF   THE   EMPIRICS. 


As  these  physicians  rejected,  absolutely,  the  latent  causes,  and  the 
so  called  essential  elementary  or  primitive  properties  of  disease,  they 
could  not  admit  the  definitions  of  the  Dogmatists,  which  are  based,  for 
the  most  part,  on  the  pretended  essence  of  things,  or  on  their  proximate 
or  occult  cause.  They  replaced  them,  therefore,  by  a  simple  description, 
called  hypotyposis,  which  consists  in  an  abridged  enumeration  of  the 
sensible  phenomena.  Thus,  instead  of  defining  fever,  like  Galen,  to  be 
an  unnatural  fire  fixed  in  the  heart ;  or,  with  Asclepiades,  an  accelerated 
movement  of  the  blood,  occasioned  by  the  obstruction  of  the  pores  ;  or, 
with  Erasistratus,  an  affection  proceeding  from  the  passage  of  the  blood 
from  the  veins  into  the  arteries,  they  say,  fever  is  an  affection  which 
manifests  itself  by  an  acceleration  of  the  pulse,  the  augmentation  of 
heat,  accompanied  often  by  thirst.  While  Galen  made  health  consist 
in  the  normal  temperament  of  the  heat,  cold,  dryness,  or  moisture,  of 
the  different  parts  ;  in  the  exact  proportion,  number,  and.  situation  of 
compound  parts,  and  in  the  perfect  mixture  of  the  humors,  the  Empirics 
said,  very  simply,  that  a  man  was  supposed  to  be  in  good  health,  when 
he  enjoyed  the  complete  exercise  of  all  his  functions. 


EXTLANATION. 


I  must  remark,  apropos  to  the  definitions,  that  the  doctrine  of  the 
ancient  Empirics  is  very  singularly  related  to  that  of  modern  Sensualists. 
The  Empirics  rejected  occult  causes,  and  the  properties  called  essen- 
tial, or  primitive  ;  they  denied  that  we  are  able  to  know  the  intimate 
nature  of  things,  that  is  to  say,  what  things  are,  in  themselves.  They 
assumed,  that  we  are  able  to  seize  only  the  i-elation  of  things  to  us,  and 
among  themselves,  because  these  relations  are  due  to  our  sensations,  and 
all  our  knowledge  comes  through  the  organs  of  sense.  They  insist  that 
our  judgment  and  reason,  in  the  facts  of  Medicine,  can  never  pass  the 
limits  of  the  capacity  of  our  senses.  In  fine,  they  replace  definitions 
by  simple  descriptions,  which  accords  with  thepractice  of  modern  Sen- 
sualists.^"' 

ANATOMY    AND   PHYSIOLOGY, 

The  Empirics  are  reproached  with  having  neglected  anatomy  and 
physiology.  This  is  supposed  by  some,  however,  to  be  exaggerated ;  they 
did  not  deny,  absolutely,  the  utility  of  these  two  branches  of  medical 
science,  but  regarded  them  as  accessory ;  yet  they  placed  clinical  obser- 
vation before  all.  It  is  difficult  to  know  the  truth,  on  this  point,  while 
we  only  know  the  opinions  of  the  Empirics  through  their  adversaries. 

*^  See  Art  de  Penser,  de  Condillac,  part.  1,  chap,  viii  and  x. 

13 


218  ANATOMICAL   PERIOD. 

It  does  not  appear  reasonable,  that  the  disciples  of  the  greatest  anato- 
mists of  antiquity  could  have  denied  the  importance  of  the  discoveries 
of  their  masters.  However  this  may  he,  if  the  coryphei  of  Empiricism 
Lave  committed  this  medical  heresy,  they  are  so  much  the  more  culpa- 
ble, as  it  is  in  flagrant  contradiction  to  the  fundamental  principle  of 
their  doctrine.  How  could  the  philosophers,  who  supposed  all  ideas 
derived  from  sensations,  depreciate  anatomy — tiie  only  one  of  the  depart- 
ments of  Medicine  which  owes  almost  nothing  to  reasoning,  and  which 
obtains,  on  the  contrary,  all  its  light  from  observation?  Besides,  is  it  not 
evident,  that  a  knowledge  of  anatomy  is  necessary  for  the  practice  of 
surgery?  As  to  physiology,  the  ancient  Empirics  are  somewhat  excusa- 
ble for  having  despised  it :  because,  in  their  time,  the  science  was,  in 
general,  made  up  of  long  dissertations  on  the  principle  of  life,  the  ele- 
ments of  the  body,  the  primary  cause  of  generation,  and  a  crowd  of 
other  mysteries,  just  as  impenetrable.  But  by  the  side  of  this  tran- 
scendental and  empty  physiology,  they  reared  another,  less  ambitious, 
which  following  anatomy,  step  by  step,  was  limited  to  the  description 
of  the  functions  of  organs  of  which  anatomy  showed  the  form,  situa- 
tion, and  structure.  This  last  physiology,  which  I  call  organic,  to 
distinguish  it  from  the  other,  is  eminently  useful,  and,  I  will  say. 
indispensable,  to  the  pathologist  and  practitioner. 

THERAPEUTICS. 

In  the  remote  ages,  as  we  have  heretofore  said,  there  was  no  thera- 
peutic axiom.  When  a  treatment  was  successful  in  one  affection,  and 
there  occurred  afterward  other  analogous  cases,  or  that  appeared  as  such, 
the  same  treatment  was  employed,  without  inquiring  whether  it  acted 
in  virtue  of  one  principle  or  another.  The  conduct  of  those  who  practiced 
Medicine  in  those  primitive  times,  was  purely  instinctive ;  but  proper 
reflection  will  show,  that  that  instinct  had  for  a  basis  an  infallible 
axiom,  which  we  have  announced  heretofore,  and  which  it  will  be  well 
to  repeat  now :  Those  remedies  which  have  cured  one  case  of  disease, 
will  cure  all  cases  analogous  to  it." 

This  axiom  has  no  need  of  demonstration ;  its  truth  strikes  us  like 
an  axiom  in  mathematics.  Nevertheless,  Hippocrates  and  his  disciples 
believed  it  their  duty  to  substitute  another  in  its  place  ;  not  surer, 
but  which  they  believed  of  more  easy  application  in  Medicine,  to  wit : 
Diseases  are  cured  hy  their  contraries ;  which  was  adopted  almost 
unanimously,  and  is  now  invoked  by  most  physicians. 

We  have,  it  is  true,  heretofore,  pointed  out  two  books  of  the  Hippo- 
cratic  collection,  whose  authors,  without  contradicting  the  axiom,  deny 

*  See  Mystical  period. 


THEORIES   AND   SYSTEMS.  21ft 

that  it  is  applicable  to  the  cure  of  all  cases.  These  authors  affirm  that 
certain  aflFections  have  been  cured  by  similars,  while  others  again  have 
been  cured  by  remedies  which  appear  neither  to  be  similar  nor  contrary 
to  the  nature  of  the  disease.'"' 

The  Empirics  went  much  farther  ;  they  assumed  that  the  intimate 
nature  of  diseases,  as  well  as  their  proximate  or  essential  causes,  being 
impenetrable,  we  can  not  hope  to  discover  the  species  of  relation  that 
exists  between  this  nature,  or  these  causes  and  the  action  of  any  remedy. 
Bleeding,  they  said,  cures  certain  inflammations  and  exasperates  others. 
Experience  teaches  us  this  ;  but  who  would  be  able  to  foresee  the  result  ? 
What  connection  is  there  between  the  subtraction  of  a  liquid  necessary 
to  life,  and  the  resolution  of  a  phlogosis  ?  A  small  dose  of  opium  often 
produces  sleep,  while  a  stronger  dose  causes  insomnia.  Is  there,  then. 
an  opposition  between  two  unequal  quantities  of  the  same  substance,  that 
it  should  produce  two  contrary  effects '?  Wine,  taken  immoderately, 
plunges  certain  individuals  into  a  lethargic  sleep  ;  but  in  others  it 
excites  a  furious  delirium.  Is  it  similar  to  the  nature  of  the  first,  and 
contrary  to  that  of  the  second,  or  vice  versa  ? 

Those  who  maintain  that  it  is  necessary  to  know  the  essence  of  a  dis- 
ease, before  treating  it,  should  at  least  agree  on  what  the  essence  is. 
But  if  you  ask  some  of  them,  in  what  consists  the  nature  of  a  phlegmon, 
one  will  respond,  that  it  is  a  tumor,  caused  by  the  excessive  heat  of  the 
blood ;  others,  by  the  acridity  of  the  bile ;  a  third,  by  the  closing  of  the 
pores;  a  fourth,  by  the  extravasation  of  the  blood,  etc.  But,  while 
waiting  for  the  dispute  to  terminate,  if  ever,  what  guide  shall  we  take, 
to  treat  properly  a  tumor  of  this  kind  ?  Certainly  there  is  none  other 
than  experience.  Experience,  alone,  has  taught  us  what  we  must  do  in 
such  a  case. 

All  that  may  be  affirmed  for  a  treatment  which  has  been  successful 
in  disease,  is,  that  it  will  procure  the  same  success  afterward,  if  it  be 
employed  against  the  same  concourse  of  pathological  phenomena.  Thus, 
therefore,  the  important  and  essential  matter  in  order  to  make  the  cura- 
tive indications  as  precise  as  possible,  is  to  observe  carefully,  and  define 
well,  the  pathological  phenomena. 

As  the  practitioners  of  the  same  epoch  employed  very  nearly  the 
same  means  of  cure,  notwithstanding  the  divergence  in  their  theories, 
the  Empirics  concluded  that  in  reality  all  were  influenced  to  do  so  by 
experience,  which  varies  but  little,  while  theoretical  explanations  con- 
tradict themselves  incessantly. 

*  ffiuvres  d'Hippocrate,  trad,  par  Littre,  T.  I :  Traite  de  I'Ancienne  Medicine, 
from  §  10  to  20,  inclusive.     Traite'  des  Lieux  dans  rHomme,  !?§  67,  6-^,  69,  70. 
Note. — Every  physician  knows  the  aphorism  :  A  vomit  will  often  cure  vomiting. 


220  ANATOMICAL   PERIOD. 


COROLLARY. 


Moreover,  the  question  which  we  now  discuss  is  one  of  the  most  inter- 
esting and  intricate.  It  constitutes  the  basis  of  therapeutics,  or  of  the 
Art,  properly  speaking.  It  has  been,  at  various  epochs,  the  subject  of 
long  debates,  and  must,  therefore,  be  presented  more  than  once  in  the 
course  of  this  history,  and  particularly  apropos  to  modern  theories. 
It  is  not  yet,  therefore,  the  proper  time  to  discuss  it  in  full.  I  will  only 
say,  in  anticipation,  that  a  disease  is  never  the  result  of  a  unique 
influence. 

Take,  for  example,  several  individuals  wounded  by  a  sharp  instru- 
ment, in  the  same  manner,  and  in  the  same  region  of  the  body.  Here 
is  a  very  simple  aff"ection ;  nevertheless  it  is  probable  that  it  would  not 
run  the  same  course  in  all,  on  account  of  individual  peculiarities,  which 
are  so  different.  Thus,  in  the  most  simple  cases,  the  disease  is  always 
subjected  to  several  simultaneous,  or  successive  influences,  so  that  it  may 
be  regarded  as  the  result  of  several  forces.  Now,  to  neutralize  the  bad 
■  effects  of  this  result,  and  to  destroy  it,  it  is  not  always  necessary  to 
oppose  to  it  an  influence  directly  contrary,  and  of  an  equal  or  superior 
energy.  Ordinarily,  we  may  suppose  that  it  will  suffice  to  change  the 
direction  of  this  result,  or  moderate  its  intensity,  by  modifying  one 
alone,  or  a  few  of  its  component  forces. 

ORIGIN   OF   PHILOSOPHIC,    OR   RATIONAL   EMPIRICISM. 

Some  authors  think  that  Empiricism  is  a  deduction  from  the  Skeptical, 
or  Pyrrhonean  doctrine.  Galen  seems  to  be  of  this  opinion,  when  he 
advises  an  Empiric  to  imitate  the  modest  conduct  of  a  Pyrrhonean  phi- 
losopher, to  prove  himself  as  simple,  sincere,  exempt  from  all  ambition, 
and  seeking  to  prove  the  excellency  of  his  doctrine,  by  a  skillful  and 
happy  practice,  rather  than  by  a  long  discourse.'--' 

Kurt  Sprengel  adopts  the  above  sentiments  of  Galen,  and  asserts 
that  medical  Empiricism  is  a  consequence  and  ofi'-shoot  of  philosophic 
Skepticism. f  Xeverthcless,  Sextus  Empiricus,  a  medical  philosopher 
who  lived  at  the  commencement  of  the  third  century  of  the  Christian 
era,  and  who  has  left  an  apologetic  explication  of  the  Pyrrhonean  phi- 
losophy, denies  that  there  is,  between  that  doctrine  and  Empiricism,  the 
analogy  that  many  persons  have  supposed  they  have  seen. J 

This  diflerence  of  opinion  obliges  me  to  throw  a  comparative  coup 
d'ceil  on  the  two  systems.  1.  The  Pyrrhonean  philosophy  rests  in 
doubt  in   regard  to  every  thing,  because  there  exist,  according  to  it, 


"  De  Subfiguratione  Empirica,  cap.  xiii. 

f  Histoire  de  la  Medicine,  Paris  1815,  T.  I,  p.  4G9,  et  suiv. 

I  Text.  Empir.  Pyrrhon.  Hypotyp.  lib.  i,  cap.  xxxiv. 


THEORIES   AND   SYSTEMS.  221 

equal  reasons  for  affirmation  and  negation,  in  all  questions.  The 
Empiric  rejects  the  opinions  which  are  not  immediately  derived  from  the 
senses,  but  admits  the  certainty  of  facts,  and  truth  of  observations. 

2.  The  Pyrrhonian  philosopher  says,  that  there  are  sensations  which  are 
pleasant,  and  others  that  are  disagreeable ;  it  offers  as  an  example,  that 
honey  is  sweet  to  the  taste — that  pain  is  distressing ;  but  if  asked,  iu 
what  consists  the  essence  of  the  sweet  taste,  and  the  suffering  of  pain, 
be  ingenuously  acknowledges  his  ignorance,  and  replies,  that  he  knows 
nothing  about  it.  The  Empiric  accords  with  the  Pyrrhonean  in  this :  he 
confesses  that  he  is  completely  ignorant  of  the  essence  of  things,  and 
affirms,  moreover,  that  the  question  is  impenetrable,  because  it  is  inap- 
preciable to  the  senses.  The  Dogmatist  on  the  contrary  does  not  hesi- 
tate to  give  an  explanation  of  the  essence ;  he  will  tell  you  that  pain 
proceeds  from  a  disjunction  of  the  elements,  and  that  the  sweet  taste  is 
derived  from  the  temperate  mixture  of  heat,  cold,  dryness,  and  moisture.''- 

3.  The  Pyrrhonean  is  naturally  inclined  to  inaction,  never  feeling  a 
positive  motive  to  take  a  part.  In  medicine  he  will  follow,  from  predi- 
lection, the  expectant  plan.  The  Empiric  employs,  on  the  contrary,  an 
active  medication.  Convinced  of  the  truth  of  the  rules  of  his  art,  which 
he  believes  deduced  from  exact  and  repeated  observation,  he  does  not 
hesitate  to  put  them  in  practice. 

This  parallel  between  the  two  doctrines  proves  that,  while  there  is 
between  them  some  similitude,  there  exist,  also,  capital  differences, 
which  prevent  us  regarding  them  as  proceeding  from  a  common  source. 
On  the  other  hand,  in  following  attentively  the  phases  of  this  history,  it 
is  easy  to  see  that  Empiricism  has  an  origin  purely  medical.  AVe  have 
seen,  in  the  first  place,  that  physicians  of  primitive  times  followed  by 
instinct  the  Empirical  method  ;  much  later,  Acron  of  Agrigcntum,  cotem- 
porary  of  Pythagoras,  affirms,  that  experience  is  the  only  true  founda- 
tion of  the  Healing  Art.  Hippocrates,  himself,  although  endeavoring  to 
attach  his  medical  doctrine  to  the  Pythagorean  dogmas  does  not  less 
proclaim,  in  many  cases,  the  superiority  of  observation  to  theory ;  and 
in  his  clinical  observations  he  shows  himself  more  careful  to  report, 
faithfully,  the  facts,  than  to  justify  his  theoretical  views. 

The  surprising  progress  of  anatomy  and  physiology,  during  the  first 
ages  of  the  Alexandrian  Institute  having  confounded  several  points  of 
the  Hippocratic  doctrine,  the  confidence  which  it  inspired  began  to 
diminish.  Then  a  thousand  new  speculations  were  hazarded,  to  explain 
the  functions  of  the  animal  economy,  which  nullified  each  other.  In 
the   midst   of  this   anarchy,  wise   practitioners,   to  whom   experience 

°  See  Galen  and  Hippocrates. 


222  ANATOMICAL   PERIOD. 

demonstrated  every  day  the  utility  of  certain  remedies,  continued, 
naturally,  to  seek  in  experience  alone,  a  refuge  from  the  incessant 
variations  of  Dogmatism,  and  the  sterile  incertitude  of  the  Skeptics. 

If,  now,  the  question  be  asked :  to  what  philosophical  doctrine  Medical 
Empiricism  is  attached,  there  is  not  one  of  my  readers  who  is  not  in  a 
state  to  respond,  that  it  is  intimately  united  to  the  sensual  philosophy  ;  a 
philosophy,  of  which  the  foundations  were  laid  by  Aristotle,  but  who 
abandoned  it  almost  immediately,  to  trace  the  rules  of  metaphysics,  and 
the  logic  of  rationalism.  In  short,  that  philosopher,  deceived  by  superfi- 
cial observation,  asserts  that  general  ideas  are  the  first  that  are  formed 
in  our  minds,  by  the  aid  of  the  senses,  and  that  they  constitute  the  prin- 
ciples— the  beginning  of  the  sciences.  Now.  modern  metaphysicians  have 
demonstrated,  that  the  sensations  give  us  only  individual  ideas ;  and  that 
general  ideas,  being  the  result  of  an  operation  of  the  understanding, 
called  abstraction,  are  the  last  formed ;  whence  it  follows,  that,  so  far 
from  being  the  foundation  stone  of  the  scientific  edifice,  they,  are  the 
key  stone  of  the  arch. 

The  Empirics  adopted  the  basis  laid  down  by  the  chief  of  the  Peri- 
patecians  ;'■■=  but,  instead  of  engaging,  as  he,  in  seeking  at  first  the  gene- 
ralities of  science,  malapropos  termed  principles,  they  confined  them- 
selves to  a  careful  collection  of  facts,  and  an  exact  narration  of  them, 
in  order  to  deduce  therefrom  rules  of  practice.  We  see  that,  in  this 
way,  they  laid  the  true  basis  of  the  Art ;  but  by  not  attempting  to  ele- 
vate themselves  to  the  most  abstract  generalities,  and  universal  axioms, 
they  left  their  work  incomplete,  not  indicating,  even  to  their  successors, 
the  final  end  to  which  they  should  direct  their  labors. 

PnOGRESS   OP  EMPIRICISM. 

The  Empirical  doctrine  took,  at  first,  a  rapid  extension ;  we  have 
already  cited  the  names  of  three  celebrated  authors,  who  taught  it 
towards  the  epoch  of  its  foundation.  Galen  cites  a  much  greater  num- 
ber, of  whom  several  wrote  much,  but  whose  works  are  entirely  lost  to 
us.  It  appears  that  in  the  time,  even,  of  that  author,  the  term  Empiric 
was  not  yet  a  disgrace,  and  that  men  of  high  public  estimation  were 
attached  to  it.  Galen,  who  was  not  accustomed  to  flatter  his  adversa- 
ries, and  who  covered  with  contempt  the  Methodists,  speaks  of  the 
Empirics  with  much  regard ;  he  avows,  more  than  once,  in  combating 
their  system,  that  their  arguments  unsettled  him.f     We  have  seen  that 

"  In  a  passage  heretofore  cited,  Aristotle  says,  formally,  that  the  sensations 
beget  ideas  and  remembrance,  from  which  flows,  subsequently,  experience,  the 
common  origin  of  the  sciences  and  the  arts. 

f  Galen,  De  Subfiguratione  Empirica,  cap.  xin.,  et  passim. 


THEORIES  AND   SYSTEMS.  223 

the  Methodist,  Aurelianus,  spoke  of  some  of  them  in  very  honorable 
terms.  Finally,  the  Eclectic,  Celsiis,  judges  them  still  more  advan- 
tageously. 

The  moderns  who  have  given  themselves  the  trouble  of  studying  the 
ancient  doctrines,  have  nearly  all  admired  the  wise  and  ingenious 
economy  of  the  system  of  the  Empirics.  I  will  cite,  among  others. 
the  historians  Daniel  LeClerc  and  Kurt  Sprengle.  The  last  expresses 
himself  thus,  in  one  of  the  passages  where  he  eulogises  Empiricism:  "I 
see,  in  all  these  principles,  the  most  evident  proof  of  the  great  sagacity 
and  sound  judgment  of  the  ancient  Empirics.  Certainly,  they  were 
more  inspired  by  the  true  genius  of  medicine,  than  most  of  their  prede- 
cessors (the  Dogmatists),  who  gave  themselves  up  to  vague  theories."-' 

The  circumstances  in  the  midst  of  which  Empiricism  was  pro- 
claimed, were  most  favorable  for  its  propagation.  Medical  theories 
had  fallen,  as  we  have  seen,  into  confusion.  All  the  principles,  meth- 
ods, and  opinions,  were  questionable.  The  recent  discoveries  in  anat- 
omy; the  introduction  of  a  considerable  quantity  of  new  medicines, 
whose  properties  were  yet  undetermined ;  the  furor  of  the  philosophic 
disputes,  which  increased,  all  disturbed  the  antique  dogmas,  without 
substituting  anything  better  in  their  place,  or,  nothing  which  obtained 
general  favor.  In  the  midst  of  such  conjectures,  a  doctrine  which  pro- 
posed to  put  an  end  to  the  perpetual  variations  of  Dogmatism,  and  avert 
the  sterile  incertitude  of  Skepticism,  by  resting  solely  on  the  evidence 
of  facts,  ought  to  have  been  received  with  enthusiasm,  especially  by  those 
practitioners,  to  whom  daily  experience  demonstrated  the  uselessness  of 
dialectics  to  advance  medicine. 

DECADENCE   OP   THE    SYSTEM   OP   THE   EMPIRICS. 

Although  Empiricism  was  founded  on  pure  observation,  we  can  not 
hesitate  to  perceive  that  it  did  not  put  an  end  to  differences  of  opinion, 
nor  incertitude ;  for  if  rationalism,  which  proceeds  from  generals  to 
particulars,  is  subject  to  deception,  the  experimental  method,  or  sensi- 
tiveism,  which  proceeds  from  particulars  to  generals,  has  also  its  grop- 
ings.  Moreover,  the  ancient  Empirics,  by  stopping  at  secondary  gene- 
ralities, without  striving  to  go  up  to  first  principles,  or,  better  still,  to 
definite  axioms,  resemble  workmen  who  stop  in  the  middle  of  the  erec- 
tion of  an  edifice.  Finally,  the  greatest  wrong  of  Empiricism,  in  the 
eyes  of  antiquity,  was,  in  not  attaching  itself  to  any  philsophic  theory 
then  known.  Such  a  doctrine,  though  able  to  captivate  practitioners 
by  its  simplicity,  could  not  satisfy  speculative  minds.  It  had  not,  then, 
the  elements  of  life  required  by  the  learned  world  at  that  epoch ;  so  ita 

=*  Hist  de  la  Med.,  T.  i,  p.  476. 


224  ANATOMICAL  PERIOD. 

fall  was  complete.  Empiricism  has  been  in  disgrace  for  many  ages,  and 
its  name  has  become  synonymous  with  ignorance.  Nevertheless,  we  shall 
see  it  revive  from  this  long  humiliation,  and  aspire,  even  rashly,  under 
the  name  of  the  Experimental  method,  to  universal  dominion  in  the 
sciences,  after  the  labors  of  Bacon,  Locke  and  Cordillac  shall  have 
cleared  up,  somewhat,  its  metaphysics. 


AET.    III.     ON    METHODISM. 

The  doctrine  of  Empiricism  had  been  proclaimed  about  a  century  and 
a  half,  and  in  that  time  a  great  number  of  celebrated  physicians 
endeavored  to  establish  the  Healing  Art  on  its  principles.  They  col- 
lected clinical  observations  with  as  much  care  as  possible,  and  made 
from  them,  model  descriptions  of  each  species  of  disease,  with  the  indi- 
cation of  those  remedies  that  had  produced  the  most  advantageous 
effects.  But  they  had  vainly  multiplied  these  model  descriptions  or 
paradigms  ;  cases  were  incessantly  appearing,  in  practice,  that  presented 
different  features  from  those  that  had  been  observed,  which  required 
the  construction  of  new  theorems ;  for,  according  to  this  doctrine,  every 
concourse  of  symptoms  not  before  described  by  authors,  was  thought  to 
represent  a  new  disease.  In  this  way,  there  was  a  tendency  to  an 
indefinite  multiplication  of  morbid  species,  and  the  Empirics  fell  into 
the  same  defect  of  which  Hippocrates  had  reproached  the  Cnidians ;  a 
defect  which  must  inevitably  lead  to  confusion,  so  long  as  similar  kinds 
were  not  united  in  a  common  species,  and  analogous  species  into  other 
groups  of  a  superior  order ;  in  short,  so  long  as  they  did  not  rise  from 
secondary  generalities  to  more  elevated  ones.  Thus,  pure  Empiricism, 
such  as  its  founders  had  conceived,  had  reached  its  limit,  and  could 
render  no  further  services  to  science,  and  though  it  had  laid  the  true 
foundation  of  the  edifice,  was  incapable  of  continuing  and  completing 
perfectly  the  structure. 

In  the  meanwhile,  a  man  endowed  with  rare  intelligence,  and  a 
remarkable  faculty  of  elocution,  but  better  versed  in  the  doctrines  of 
the  philosophers  and  grammarians  than  in  the  practice  of  ]\Iedicine, 
Asclepiades,  of  Bythinia,  came  to  Eome  with  the  intention  of  teaching 
rhetoric.  The  charms  of  his  mind,  his  talents,  and  his  address,  gave 
him,  immediately,  access  to  the  most  illustrious  persons  of  the  Eepub- 
lic.  He  taught  eloquence,  for  a  time,  with  great  eclat,  and  as  early 
as  the  one  hundred  and  fiftieth  year  before  Christ,  enjoyed  a  high 
reputation  as  a  rhetorician,  for  Cicero  honored  him  with  his  intimacy. 
Notwithstanding  this,   he  abandoned  the  career  of  letters,   to  under- 


THEORIES   AND   SYSTEMS.  225 

take  the  practice  of  Medicine ;  but,  being  unwilling  to  follow  in  the 
tracks  of  his  predecessors,  he  took  upon  himself  to  create  a  new  sys- 
tem. Imbued  with  the  philosophy  of  Epicurus,  then  in  high  repute 
among  the  higher  classes  of  Eoman  society,  he  deduced  from  it  a  theory 
which  united  to  its  merit  as  a  novelty,  that  of  being  in  harmony  with 
the  philosophic  ideas  most  in  vogue. 

Asclepiades  taught,  as  a  consequence  of  the  dogmas  of  Democritus 
and  Epicurus,  that  the  elements  of  the  body  existed  from  all  eternity  ; 
that  they  are  incommutable  in  their  essence,  indivisible,  impalpable, 
and  perceptible  to  reason  only.  These  elements,  which  he  named  atoms, 
possessed  no  quality,  per  se,  but  were  of  various  shapes,  and  animated 
by  a  perpetual  motion  ;  and  that  from  their  frequent  encounters  and 
fortuitous  combinations,  all  sensible  things,  all  the  phenomena  of  the 
universe,  were  supposed  to  result.  "When  any  one  asked  this  innova- 
tor, how  it  was  that  the  body  could  be  endowed  with  properties,  when 
its  constituent  parts  had  none,  he  replied,  that  compounds  and  aggre- 
gates differ  very  much  from  their  elements ;  that  the  order  and  num- 
ber in  which  the  atoms  became  united,  the  shape  and  size  of  bodies 
which  resulted  from  their  aggregations,  were  the  sole  causes  of  the 
properties  observed  in  them.  Solid  silver,  he  said,  is  white,  but  reduced 
to  powder,  it  appears  black ;  the  horn  of  the  goat,  on  the  contrary,  is 
black,  but  if  it  be  rasped,  the  particles  are  white. 

Passing  from  general  physics  to  physiology,  Asclepiades  affirmed  that 
the  human  body  is  formed  of  tissues  every  way  permeable,  that  is, 
pierced  with  invisible  holes,  which  he  named  pores,  through  which 
passed  and  repassed,  continually,  atoms  of  various  shapes  and  sizes. 
He  pretended  to  explain  all  the  physiological  and  pathological  functions, 
the  secretions,  sensibility,  pain,  etc.,  by  the  spontaneous  movements  of 
the  atoms,  and  their  continual  passage  through  the  pores  of  the  body. 
Health  depended  on  the  extent  of  the  exact  symmetry  of  the  pores  with 
the  atomic  molecules.  Besides,  he  repelled,  with  derision,  the  hypothe- 
sis of  a  motive  principle  in  the  animal  economy,  endowed  with  instinct, 
and  watching  over  the  preservation  of  the  entire  body  or  any  of  its 
parts.  He  ridiculed  the  theory  of  Hippocrates,  on  coction,  crisis  and 
critical  days,  for  he  did  not  expect  any  beneficial  action  from  the  efforts 
of  nature,  and  relied  entirely,  for  the  cure  of  the  sick,  upon  the  skill  of 
the  physician.  He  called  the  circumspect  therapeutics  of  the  venerable 
man  of  Cos,  a  meditation  on  death. 

If  the  physiological  explanations  of  Asclepiades  were  but  little  cal- 
culated to  deceive  a  thoughtful  mind,  and  especially  physicians,  who 
were  accustomed  to  watch  the  progress  of  diseases,  his  therapeutical 
maxims  were  eminently  calculated  to  secure  to  him  the  confidence  of 


226  '  ANATOMICAL  PERIOD. 

the  sick.  He  proposed  no  other  aim  in  his  treatment,  than  to  enlarge 
the  pores  when  they  were  too  contracted,  as  the  result  of  the  constric- 
tion of  tissues,  and  to  close  them  when  they  were  too  open.  To  attain 
this  end,  he  said,  only  certain,  prompt,  and  agreeable  means  should  be 
employed.  Consequently,  he  rejected  all  violent  remedies,  such  as 
vomits,  drastics,  incisions,  and  the  cautery.  He  employed  blood- 
letting rarely,  and  recognized  only  a  small  number  of  surgical 
operations.  His  favorite  remedies  were  generally  taken  from  hygiene, 
such  as  walking  and  other  physical  exercises,  riding  on  horseback, 
in  carriage,  and  in  boat- rowing ;  frictions  executed  in  various  man- 
ners, and  wine,  which  he  administered  frequently,  either  pure  or  med- 
icated, etc. 

Unquestionably,  these  means  are  useful  in  many  cases ;  employed 
appropriately,  and  concurrently  with  others,  they  render  great  service, 
especially  in  chronic  affections,  and  during  convalescence ;  but  to  limit 
medical  counsel  to  their  use  alone,  and  to  abstain  voluntarily  from  many 
other  resources,  more  powerful,  is  to  exhibit  a  desire  to  please  patients, 
and  obtain  their  good  will,  rather  than  to  be  desirous  of  restoring  them 
to  health.  Thus,  Asclepiades,  aiming  at  a  circumstantial  success,  rather 
than  at  solid  reputation,  obtained,  notwithstanding  all  his  talents,  but 
an  ephemeral  celebrity. 

Themison  of  Laodicea,  a  disciple  of  Asclepiades,  was  led  by  the  teach- 
ings of  his  master,  to  lay  the  true  foundation  of  Methodism.  After 
having  divided,  like  him,  all  diseases  into  two  great  classes,  under  the 
title  of  acute  and  chronic  affections,  he  separated  each  class  into  three 
species,  viz :  the  constrictive  or  contracted  ;  the  fluxionai'y  or  relaxed  ; 
and  the  mixed.  Then  he  established  the  distinction  of  these  species, 
not  on  the  occult  qualities  of  the  Dogmatists,  nor  on  the  consideration, 
no  less  hypothetical;  of  the  state  of  the  pores,  but  on  the  sensible  char- 
acters drawn  from  medical  observation.  He  called  these  characters, 
sometimes,  communities,  because  they  were  common  to  diseases  of  the 
same  species,  and  again  similitudes,  because  they  indicated  certain  like- 
nesses or  similitudes  in  diseases. 

The  communities  of  the  constrictive  species,  are  swelling,  tension,  and 
hardening  of  structures,  the  partial  or  complete  suppression  of  some 
natural  evacuation,  all  the  signs,  in  short,  that  indicate  the  constric- 
tion of  tissues.  The  communities  of  the  relaxed  species  are  softening 
of  tissues,  the  diminution  of  the  entire  volume  of  the  body,  or  some  of 
its  structures ;  the  increase  of  ordinary  evacuations,  or  the  appearance  of 
some  abnormal  evacuation.  Lastly,  the  communities  of  the  mixed 
species  consisted  in  a  mixture,  a  coincidence  of  signs  that  indicated 
both  constriction  and  relaxation. 


THEORIES   AND   SYSTEMS.  227 

Themison  had  attained  an  advanced  age  when  he  published  his  plan 
of  reform,  and  we  are  ignorant  to  what  degree  of  perfection  he  carried 
it.  We  know,  simply,  that  Thesalus  of  Tralles,  and  Soranus  of  Ephesus, 
made  changes  in,  and  additions  to  it ;  but  it  is  impossible  to  say  pre- 
cisely, what  part  each  of  these  authors  took  in  the  creation  of  the  sys- 
tem of  the  Methodists,  now  when  all  their  works  have  been  lost.  There 
exist  none  of  the  writings  of  this  sect,  but  the  treatise  of  Ccelius  Aure- 
lianus,  of  whom  I  have  already  spoken  ;  and  it  is  the  work,  from  which 
we  have  extracted,  almost  entirely,  what  we  have  said  concerning  the 
doctrine  of  Methodism.  The  following  will  show  the  arrangement  of 
diseases :  first,  the  constrictive  of  the  acute  variety ;  apoplexy,  angina, 
lethargy,  convulsions,  ileus,  madness,  etc. ;  of  chronic  affections,  cepha- 
lalgia, vertigo,  epilepsy,  mania,  jaundice,  amennorrhea,  obesity,  etc. ; 
secondly,  the  relaxed  species :  cardialgia  or  gastralgia,  cholera,  hema- 
temesis,  and  other  hemorrhages,  including  the  hemorrhoidal  flux  ;  thirdly, 
and  lastly,  of  the  mixed  species :  peripneumonia,  pleurisy,  colic,  disen- 
tery,  etc.,  asthma,  paralysis,  catarrhs,  phthisis,  etc. 

It  is  plain  that  there  is  much  that  is  arbitrary  in  the  above  classifi- 
cation. Besides,  the  Methodists  were  not  agreed  amongst  themselves,  on 
the  class  in  which  several  of  these  should  be  placed :  some,  for  instance, 
insisting  that  hydropsy  belonged  to  the  constrictive  class,  others  to  the 
relaxed ;  some  thought  asthma  should  be  enrolled  among  the  mixed, 
others,  that  it  belonged  to  the  fluxionary  species,  and  so  forth.  But  the 
greatest  reproach  that  can  be  brought  against  the  classification  of  the 
Methodist,  is  the  union  of  very  differeiit  diseases,  in  one  community, 
and  the  separation  of  analogous  ones.  However  this  may  be,  this 
attempt  at  a  pathological  classification,  founded  on  the  evident  characters 
of  diseases,  and  not  on  occult  causes,  or  imaginary  qualities,  was  a  great 
progress. 

It  followed  from  this  division  of  diseases,  that  with  the  ^Methodists 
there  were  only  two  kinds  of  therapeutical  indications  to  fulfill,  viz. :  to 
relax  when  there  was  constriction,  and  to  constrict  where  there  was  a 
flux  or  relaxation.  Also,  they  admitted  but  two  modes  of  treatment, 
which  they  named  curative  communities.  All  therapeutic  agents  were 
comprised  in  one  or  the  other  of  these  communities.  Blood  letting,  for 
example,  cups,  emollient  cataplasms,  warm  and  laxative  drinks,  sudo- 
rifics,  warm  air,  sleep,  exercise  carried  to  fatigue,  etc.,  form  a  part  of 
the  community  of  relaxants.  Darkness,  fresh  air,  cold  and  acidulated 
drinks,  decoction  of  the  quince,  red  wine,  or  vinegar,  solution  of  alum, 
etc.,  were  ranked  in  the  community  of  astringents. 

Some  Methodists  admitted  a  third  curative  resource,  which  they 
named  prophylactic.     It  comprised   all  the  special  means  in  use,  to 


228  ANATOMICAL   PERIOD. 

prevent  or  arrest  tlie  toxic  cfiFects  of  poisons  and  venemous  substances. 
But  the  pure  Methodists,  such  as  Aurelianus,  rejected  this  community, 
and  wouhl  not  admit  specific  remedies,  any  more  than  specific  diseases. 
They  erased  from  their  materia  medica,  purgatives,  diuretics,  emmena- 
gogues,  anodynes,  somnifera,  etc.,  excepting  from  this  general  proscrip- 
tion vomits  only,  which  they  gave,  not  with  a  view  of  evacuating  the 
bile  or  phlegm,  like  the  Dogmatists  and  Empirics,  but  to  give  the 
economy  a  shock  which  would  open  its  pores,  and  change  the  general 
disposition  of  things. 

In  the  progress  of  diseases,  the  Methodists  distinguish  three  periods, 
or  temporary  conditions,  viz. :  the  periods  of  development,  stasis  and 
decline.  Each  of  these  temporary  conditions  required  particular  care, 
and  became  the  source  of  the  curative  indications. 

Lastly,  there  was  added  a  fourth  or  last  community,  called  chirurgical, 
that  embraced  all  the  operations  of  surgery.  It  consisted  in  removing 
from  the  body  the  things  which  were  foreign  to  it,  and  unnatural.  This 
lass  was  subdivided  into  several  others,  accordingly  as  the  foreign  or 
unnatural  things  were  of  external  origin,  as  a  thorn,  an  arrow,  etc.,  or, 
as  they  were  from  within,  as  a  tumor,  an  abscess,  an  excrescence,  an 
ulcer,  or  hair-lip,  etc. 

By  the  help  of  these  summary  considerations,  touching  the  common 
symptoms  of  diseases,  and  their  curative  indications,  the  Methodists 
believed  they  might  dispense  with  all  ulterior  research.  They  did  not 
inquire  for  the  causes,  whether  occasional  or  proximate,  because  they 
said  from  the  moment  that  the  disease  is  developed,  it  is  necessary  to 
cure  it.  The  indications  in  diseases  were  to  be  drawn  from  its  nature, 
characters  and  progress,  and  not  from  anterior  circumstances,  which 
exert  no  influence.  Now,  the  nature  of  diseases  consisted,  uniquely, 
according  to  them,  in  the  conditions  or  communities  of  which  I  have 
spoken.  Neither  did  they  attach  much  value  to  the  precise  knowledge 
of  the  seat  of  the  disease,  or  affected  parts ;  nor  to  the  consideration  of 
the  age  of  the  patient — his  habits — the  general  state  of  his  forces — nor 
to  climate  and  season.  They  assumed  that  these  details  were  superflu- 
ous, and  could  not  affect  any  notable  modification  of  the  treatment. 
For,  according  to  their  system,  an  affection  of  the  constrictive  species, 
such,  for  example,  as  an  inflammatory  tumor,  always  requires  the  same 
kind  of  treatment,  whatever  may  be  its  locality,  or  the  age  of  the 
patient,  the  climate  or  the  season.  If,  sometimes,  they  gave  attention 
to  the  region  particularly  aff'ected,  it  was  only  for  the  purpose  of  apply- 
ing the  topical  treatment  indicated,  more  exactly  at  the  seat  of  the 
disease. 

The  Empirics,  anxious  to  secure  themselves  from  the  error  into  which 


THEORIES   AND   SYSTEMS.  229 

the  search  for  proximate  causes,  first  principles  and  elements,  had  drawn 
their  predecessors,  the  Dogmatists,  could  think  of  nothing  better  than 
to  banish  from  science  all  transcendent  generalities.  Finally,  then,  to 
keep  as  near  as  possible  to  the  truth,  based  on  observation,  they  estab- 
lished as  many  morbid  species  as  they  had  encountered  diiferent  assem- 
blages of  symptoms.  This  resulted,  at  length,  in  such  a  multitude  of 
species,  that  it  became  extremely  difiicult  to  recognize  them,  separately, 
especially  as  some  among  them  were  only  separated  from  each  other  by 
light  shades  of  difference.  To  obviate  this  embarrassment,  it  was  neces- 
sary, as  we  have  already  said,  to  unite  together  all  the  analogous  morbid 
species,  and  form  them  into  genera,  which  being  few  in  number,  and  dis- 
tinguished from  each  other  in  a  marked  manner,  could  easily  be  recog- 
nized; then,  with  a  knowledge  of  the  genus,  the  mind  could  easily 
descend  to  a  determination  of  the  species.  In  this  way,  a  philosophic 
method  serves  as  a  lever  to  the  feebleness  of  our  understanding. 

But  the  Methodists  misconceived  the  true  use  of  the  groups  of  the 
second  order,  i.  e.,  the  genera  which  they  had  established.  Instead  of 
making  use  of  them  to  arrive  more  conveniently  at  the  determination 
of  the  species,  they  rejected  them  as  useless,  and  preferred  to  rely  exclu- 
sively upon  their  general  principles ;  so  that  they  would  treat  by  the 
same  means,  mania,  jaundice,  amenorrhea,  etc.,  which  are  chronic  affec- 
tions of  the  constrictive  genus ;  and,  on  the  other  hand,  peripneumonia, 
colic,  dysentery,  etc.,  acute  affections  of  the  mixed  order,  were  also  all 
treated  alike.  They  had  no  regard,  either  to  the  natural  tendency  of 
the  vital  forces,  or  to  coction  or  crisis,  or  a  multitude  of  other  essential 
circumstances  which  we  have  lately  enumerated.  Lastly,  they  had 
much  less  regard  for  anatomy  and  physiology  than  the  Empirics.  Their 
desire  to  simplify  the  practice  of  medicine  was  so  great,  that  they  sub- 
mitted all  their  patients  to  a  uniform  regimen.  They  were  all  required 
to  fast  for  the  first  two  or  three  days.  During  the  second  ternary,  they 
allowed  them  a  small  quantity  of  food,  and  so  OU;  increasing  their  nour- 
ishment gradually,  every  three  days.  Their  mania  for  uniformity  is 
nowhere  revealed  more  sensibly,  than  in  the  mode  of  treatment  called 
the  metasyncritic  circle,  or,  more  simply,  metasyna-isis,  which  they 
employed  in  very  obstinate  affections,  after  having  exhausted  their  ordi- 
nary means.  The  following  is  a  description  of  the  famous  metasyncritic 
circle,  as  given  by  Coelius  Aurelianus,  in  his  treatise  on  chronic  diseases, 
Book  first,  chapter  first : 

"  The  first  day,  the  patient  must  fast;  the  next  day,  after  being  car- 
ried into  the  open  air  for  a  short  time,  he  is  to  be  anointed,  and  even 
bathed,  if  his  pain  permit ;  then  he  is  to  receive  one-third  the  quantity 
of  bread  which  he  was  in  the  habit  of  usinsr  in  health.     He  is  also 


230  ANATOMICAL   PERIOD. 

allowed  to  eat  salted  and  roasted  meats,  dressed  with  mustard,  green 
olives  preserved  in  salt,  and  other  things  of  the  same  nature ;  but  he 
must  abstain  from  pork,  from  garlic,  onions,  and  other  herbs  which  excite 
the  brain.  As  a  beverage,  he  shall  have  wine ;  and  this  diet  is  to  be 
continued  for  two  or  three  days,  if  he  can  support  it :  and  sometimes 
fish  and  brain  are  to  be  added  to  the  above  mentioned  meats.  After 
this,  the  second  third  of  the  bread  of  which  he  was  deprived  may  be 
allowed,  with  brain  and  fish,  and  herbs,  for  two  or  three  days.  Finally, 
his  full  amount  of  bread  is  to  be  given  to  him,  and  the  former  meats 
exchanged  for  that  of  fowls ;  which  latter  is  to  be  continued  as  long  as 
the  preceding ;  and,  lastly,  is  to  be  followed  by  the  uhe  of  pork. 

"  If  it  is  desirable  to  change  more  frequently,  the  bread  may  be 
divided  into  four  parts — so  that  one  part  may  be  given  at  each  change 
of  the  meats — thus,  the  first  part  is  given  with  the  middle  diet,  another 
with  fowl,  a  third  with  game,  and  the  fourth  with  pork ;  but,  to  prevent 
the  patient  becoming  disgusted  by  eating,  for  so  many  days,  the  same 
sort  of  meats,  it  is  necessary  to  vary  as  much  as  possible,  each  kind  of 
food.  The  first  day,  for  example,  when  he  uses  salt  meats,  he  should 
make  the  meal  with  a  sardine,  and  a  little  sea-fish.  When  he  uses 
middle  diet,  which  is  composed  of  fowl,  he  must  use  sometimes  a  thrush, 
and,  at  others,  the  titlark,  or  snow-birds,  or  young  pigeons.  Apples 
may  also  be  given,  in  small  quantities,  so  as  not  to  produce  flatulency. 
When  pork  is  used,  vegetables  must  be  added,  taking  care  not  to  allow 
too  many  nor  too  rich  articles.  In  changing  from  one  sort  of  diet  to 
another,  frictions,  and  water  as  an  excl'nsive  beverage,  are  to  be  used : 
but,  on  the  following  days,  wine  may  be  given,  and  a  bath  be  taken.  It 
is  unnecessary,  nevertheless,  to  bathe  every  day ;  because  too  frequent 
bathing  may  renew  the  headache.  The  movements  of  the  body  must 
be  augmented  and  diminished  b}'^  turns. 

"  This  first  part  of  the  metasyncritic  circle  being  achieved,  we  come 
to  the  second,  in  which  no  other  treatment  than  vomiting  is  to  be  pur- 
sued. During  the  intervals,  the  nutrition  drawn  from  salt  meats  and 
sour  substances  shall  be  suspended.  The  first  day,  the  patient,  after 
being  exercised  a  little,  shall  endeavor  to  procure  vomiting  by  the  use 
of  horse-radish,  or  with  other  medicines,  if  that  fail.  It  is  to  be  pro- 
cured as  follows :  one  pound  of  the  bark  of  the  root  is  taken,  which, 
being  cut  up  very  fine,  is  soaked  in  honeyed  water,  called  hydromel,  to 
which  is  added  a  little  vinegar,  or  vinegar  of  squills.  The  bark  being 
thus  prepared,  it  is  all  eaten  a  little  before  meal-time,  and  the  liquor  in 
which  it  was  infused,  drunk  in  small  quantities  at  a  time.  Afterward, 
he  must  walk  slowly,  and  then  rest  when  he  feels  a  sour  and  hot  sensa- 
tion, which  takes  place  in  about  an  hour.     Then,  he  must  take  two 


.1 


THEORIES   AND   SYSTEMS.  231 

glasses  of  lukewarm  water — not  more,  for  fear  of  weakening  the  medi- 
cine— and  put  two  fingers  down  his  throat,  so  as  to  excite  vomiting. 
This  is  to  be  continued,  until  every  thing  is  thrown  up  that  has  been 
taken.  Then  a  large  quantity  of  water  is  to  be  drunk,  to  wash  the 
stomach,  and  extinguish  the  remains  of  fire  that  the  horse-radish  may 
have  kindled  there.  After  this,  vomiting  must  be  excited  afresh  ;  and 
thus  the  water  and  vomiting  must  be  repeated  three  or  four  times  con- 
secutively, until  the  water  is  thrown  up  as  clear  as  it  is  swallowed. 

"The  vomiting  being  ended,  the  head  is  to  be  fomented,  and  the 
mouth  rinsed  with  warm  water.  After  awhile,  a  gentle  promenade 
should  be  taken,  to  relieve  the  head  from  the  agitation  and  excitement 
which  has  been  brought  about  by  the  shock  of  the  vomiting  ;  or,  what 
will  have  the  same  effect,  anointing  the  body  and  rubbing  it  with  the 
hands,  from  above  downward,  exciting  everywhere  an  easy  and  equal 
perspiration.  After  this,  two  glasses  of  warm  water  are  to  be  drunk, 
and  the  patient  put  to  bed ;  where  he  rests  in  great  repose  of  body  and 
mind,  without  eating,  or  drinking,  or  sleeping,  for  some  time,  or  until 
the  agitation  caused  by  the  remedy  ceases.  If  the  patient  be  allowed 
to  sleep,  while  the  brain  is  excited  from  the  effect  of  the  treatment,  the 
effect  of  the  sleep  being  to  produce  contraction  of  the  head,  it  would 
effect  the  contrary  of  what  is  desired.  It  is  necessary,  also,  to  abstain 
from  meats,  for  fear  of  its  decomposition  by  the  heat  and  irritation  of 
the  stomach,  resulting  from  the  vomitings,  as  well  as  the  remains  of 
the  horse-radish  sometimes  left  behind,  which,  mingling  with  the  food. 
corrupts  it,  and  gives  rise  to  flatulency ;  which,  rising  toward  the  head, 
increases  the  danger  instead  of  diminishing  it. 

"  The  following  day,  the  patient  must  bathe,  and  live  on  the  middle 
diet,  and  after  two  or  three  days,  he  should  complete  the  other  parts  of 
the  circle  commenced.  If  it  is  observed  that  the  patient  is  sensibly 
better,  and  that  he  has  intervals  of  perfect  calm,  after  having  gone 
through  again  the  resumptive  circle,  the  vomiting  should  be  resumed, 
joined  with  drimyphagy  or  the  use  of  salt  food.  In  fine,  the  rest  of 
the  metasyncritic  circle  must  be  boldh"  achieved." 

I  terminate  here  this  very  long  quotation,  though  I  have  not  half  fin- 
ished the  metasyncritic  circle ;  those  who  wish  to  know  it  in  full,  will 
find  it  by  consulting  the  original,  or  History  of  Medicine,  by  Daniel 
Leclerc,  (2  part,  liv.  iv,  sect.  1,  chap.  XI,)  what  I  have  reported  will 
suffice  to  convince  the  reader  that  this  series  of  proofs,  somewhat  severe, 
through  which  the  patient  is  made  to  pass,  is,  at  bottom,  only  a  system- 
atized perturbating  method. 

The  founders  of  Methodism  mistook  the  true  use  of  the  generali- 
ties that  they  established.     Instead  of  regarding  them  as  a  progress,  a 


232  ANATOMICAL  PERIOD. 

perfection  of  Empiricism,  as  a  means  of  retaining  and  classing  in  the 
memory  the  numerous  and  precise  details  furnished  by  that  sect,  they 
rejected  their  details ;  they  did  not  consider  each  genus  as  a  collection 
of  distinct  species,  necessary  to  be  distinguished  from  each  other,  but 
believed,  rather,  that  the  knowledge  of  the  genus  dispensed  with  that 
of  the  distinction  of  species.  They  were  ignorant,  that  the  more  an 
idea  is  general,  the  more  it  is  separated  from  objective  tnith  and  phe- 
nomenal reality  ;  and  how  could  it  be  otherwise,  when  the  greatest  meta- 
physician of  antiquity,  Aristotle,  had  said  that  the  first  ideas  formed 
in  our  minds  by  the  intermediation  of  the  senses,  are  general  ones, 
while  it  was  demonstrated,  two  thousand  years  later,  that  our  first 
ideas  are  particular  ones,  always  relating  to  individual  objects  ? 

The  Methodist  doctrine  abridged,  singularly,  the  study  of  Medicine, 
and  to  such  an  extent,  that  one  of  the  coryphei  of  the  doctrine,  Thes- 
salus,  of  Tralles,  could  say,  without  too  much  exaggeration,  that  he 
felt  able  to  teach  the  whole  Medical  Science  in  six  months.  It  is  true, 
that  inculcating  solely  in  the  minds  of  his  adepts  some  superficial 
notions  on  the  general  characters  of  diseases,  and  the  virtues  of  reme- 
dies, he  placed  them,  without  scruple,  in  the  ranks  of  the  profession, 
but  not  without  frequently  committing  blunders.  Unfortunate  were 
those  who  imprudently  placed  themselves  in  the  hands  of  these  ofi"-hand 
doctors  ;  for  they,  not  knowing  how  to  discern  the  delicate  shades  which 
separate  many  morbid  species,  overlooked  a  multitude  of  precious  indi- 
cations, and  prolonged  the  sufi"erings  of  their  patients,  or  sent  them 
into  the  other  world,  without  supposing  for  a  moment  that  it  was  the 
fault  of  their  treatment. 

t  Methodism  made  a  rapid  progress,  from  its  advent  in  the  medical 
world.  It  had,  in  the  first  place,  as  its  admirers,  the  numerous  vulgar 
herd  of  neophytes,  who  were  anxious  to  finish  their  apprenticeship,  to 
rush  into  practice.  Secondly,  it  satisfied  a  natural  penchant  of  the 
human  mind,  the  love  of  generalizations,  particularly  felt  at  that  epoch, 
and  which  Empiricism  had  not  gratified.  In  short,  it  rested  between 
Dogmatism  and  Empiricism,  as  a  mediator,  combining  the  advan- 
tages of  both  doctrines,  without  having  any  of  their  inconveniences. 
The  Methodist  said  to  the  Dogmatist :  I  adopt,  like  you,  rational  truths 
only ;  I  deduce  them  from  sensible  phenomena,  and  not  from  circum- 
stances insusceptible  to  observation. 

He  said  to  the  Empirics,  like  you  I  take  observations  for  a  guide ; 
but  I  do  not  embarrass  the  Art  with  a  multitude  of  precepts  difficult  to 
retain,  and  more  difficult  still,  to  put  in  practice.  I  deduce  from  expe- 
rience a  small  number  of  rules,  based  on  evident  signs. 

The  above  is,  without  contradiction,  a  fine  programme,  as  are  all  the 


THEORIES   AND   SYSTEMS.  233 

programmes  of  system-makers  ;  but  we  know  very  well  how  little  its  pro- 
mises have  been  fulfilled.  Galen  was  not  duped  by  this  reasoning.  He 
demolished  the  sophisms  of  the  Methodists,  and  demonstrated  the  insuflB- 
ciency  of  their  doctrine,  and  the  dangers  of  their  practice  ;  he  over- 
whelmed them  with  strokes  of  his  satire,  calling  them  the  asses  of 
Thessaly,  alluding  to  the  want  of  literary  and  medical  instruction  in 
a  great  number  of  them. 


ART.    IV.     ON    ECLECTICISM. 

If  we  now  take  a  retrospective  glance  of  the  systems  we  have  detailed, 
we  shall  see  that  in  all  of  them  there  are  some  valuable  truths, 
confirmed  by  the  reason  and  experience  of  all  ages,  while  all  arc  at  the 
same  time  tarnished  by  some  exaggeration  or  error. 

The  first  of  all  and  the  most  ancient,  Dogmatism,  directs  our  atten- 
tion especially  to  the  animal  economy,  in  health  as  well  as  disease  ;  it 
describes  admirably  the  union  of  the  vital  forces,  sympathies  of  the 
organism,  and  natural  efi'orts,  to  repel  both  internal  and  external  dele- 
terious influences.  One  of  the  most  characteristic  and  one  of  the  most 
striking  traits  of  these  phenomena  of  life,  is  their  combined  tendency 
toward  a  common  end,  which  seems  to  be  premeditated,  for  the  preser- 
vation of  the  individual,  for  a  certain  period  of  time.  This  nearly 
providential  tendency  manifests  itself,  particularly,  in  certain  acute  dis- 
eases, and  those  who  first  studied  the  progress  of  these  aflPections,  applied 
themselves,  with  a  praiseworthy  perseverance,  to  discover  the  laws  which 
control  the  vital  principal,  or  the  organic  forces,  in  each  disease.  This 
is  the  fair  side  of  Dogmatism ;  the  one  which  has  resisted  the  caprice 
of  opinion,  and  the  progress  of  light. 

But  beside  the  organic  force,  there  exist  other  forces  which  modify  the 
action  of  the  first — sometimes  deranging  and  even  masking  and  destroy- 
ing it.  These  latter  ones,  which  are  named  inorganic  or  physico-chemi- 
cal, act  sometimes  in  an  obvious  manner,  as  when  a  man  is  killed  or 
wounded  by  a  mechanical  agent  or  a  violent  poison :  again,  in  a  latent 
form,  as  when  there  is  developed  in  the  human  body  a  chronic  disease, 
by  the  influence  of  regimen,  air,  or  some  similar  cause.  The  Dogma- 
tists divided  the  external  forces  acting  on  the  animal  economy,  into  four 
species,  viz.:  heat,  cold,  dryness,  and  moisture,  which  correspond  to  the 
four  general  forms  of  matter  acknowledged  by  the  physicians  of  those 
times — fire,  air,  earth,  and  water.  Then,  to  maintain  uniformity  or 
harmony,  they  imagined  in  the  living  body  the  continual  presence  of  four 
humors ;  blood,  bile,  atra-bile,  and  pituite,  each  one  characterized  by  a 
predominance  of  one  of  the  elementary  q^ualities.  Now,  this  classification 
15 


234  ANATOMICAL  PERIOD. 

of  elementary  qualities  or  organic  forces,  their  presumed  analogy  with 
the  humors  of  the  body,  their  mode  of  action  on  the  economy,  was 
entirely  founded  on  imaginary  hypotheses  or  presumptions.  How- 
ever, the  causes  of  diseases  being  supposed  to  consist  in  the  excess  of 
some  one  of  these  qualities  or  humors,  the  treatment  was  directed 
against  these  supposed  causes.  That  was  the  weak  side  of  Dogmatism, 
and  on  which  its  enemies  attacked  it. 

The  Empirics  were  right  in  opposing  the  idea  of  inaccessible  and 
occult  causes  becoming  the  basis  of  a  rational  treatment.  They  said, 
that  the  nature  of  diseases  existed  in  the  totality  of  their  appreciable 
phemomena ;  or,  in  other  terms,  in  the  concourse  of  these  symptoms. 
They  affirmed  that  there  was  no  constant  relation  of  antagonism  or 
similitude  between  a  disease  and  the  remedy  which  cures  it. 

The  Methodists  added  a  remarkable  improvement  to  Empiricism,  by 
forming  secondary  groups,  destined  to  unite  the  primitive  groups  or  the 
species  of  the  Empirics.  I  will  not  recapitulate  here  the  defects  of 
these  systems,  because  they  must  yet  l)e  fresh  in  the  memory  of  the 
reader.  I  have  sufficiently  well  proved,  I  presume,  what  I  advanced  at 
the  commencement  of  this  chapter,  that,  in  each  one  of  the  three  great 
systems  of  Medicine  which  prevailed  during  this  historic  period,  there 
were  excellent  things,  mingled  with  defects  and  errors. 

Many  physicians  of  antiquity  held  the  same  view:  they  compre- 
hended vaguely,  that  the  entire  truth  of  Medicine  did  not  exist  in  any 
one  of  these  systems ;  but  they  could  not  precisely  state,  as  we  have 
done,  that  there  was  both  good  and  evil  in  each,  for  the  philosophic 
principles  that  guide  us  in  our  choice  were  yet  unknown.  These  physi- 
cians, not  being  able  to  establish  any  general  rule,  which  could  serve  as 
a  basis  for  their  judgments,  decided  each  particular  question  according 
to  their  taste,  fancy,  or  reason.  They  assumed  the  name  of  Eclectics  or 
Episynthetics,  to  convey  the  idea  that  they  adopted  no  system  exclu- 
sively, but  took  from  each  whatever  was  best  in  it. 

The  Eclectics  do  not  form  a  sect,  since  they  had  no  precise  dogma  or 
theory  of  practice  which  was  common  to  each  and  all  who  were  con- 
nected with  them.  They  professed  to  follow,  on  every  occasion,  the 
lights  of  reason  and  experience  only ;  but  that  is  a  common  idea  which 
all  the  sects  invoke,  and  which  is  not  characteristic  of  any  one  in  par- 
ticular. The  habitual  state  of  an  Eclectic  is  that  of  doubt  and  incer- 
titude, so  that  they  may  be  confounded  with  the  Pyrrhonians  at  first 
sight ;  but  reflection  will  show,  that  the  doubt  of  the  latter  was  abso- 
lute and  universal,  being  the  result  of  the  principle  they  held,  while  the 
doubt  of  the  Eclectic  had  no  foundation  in  principle,  but  was  only  the 
eflFect  of  uncertainty. 


THEORIES   AND   SYSTEMS.  235 

Eclecticism,  in  Medicine,  is  the  absence  of  all  fixed  principle,  or,  as 
I  have  said  in  my  introduction,  it  is  individualism  erected  into  a  dogma. 
Like  the  Proteus  of  the  fable,  it  can  not  be  seized,  because  it  has  no 
regular  form ;  it  escapes  refutation,  because  it  is  entirely  deficient  in 
principles.  Many  practitioners  were,  or  called  themselves.  Eclectics,  to 
avoid  the  discussion  of  principles,  to  which  they  were  little  inclined  or 
apt.  Besides,  with  this  profession  they  had  the  greatest  possible  lati- 
tude, on  any  particular  occasion,  to  adopt  the  sentiments  which  they 
thought  best.  In  fine,  an  Eclectic  is  a  man  destitute  of  any  profound 
conviction,  like  a  citizen  who,  in  the  midst  of  internal  dissentions,  sides 
with  no  party,  weai-s  no  colors,  is  committed  to  no  pex'son,  and  who,  on 
account  of  his  indiflFerence  even,  is  perhaps,  the  better  prepared  to 
judge  with  impartiality  the  acts  and  arguments  of  each  faction.  - 

RESUME    OF    THE    ANATOMICAL    PERIOD. 

We  have  now  seen  that  medical  studies,  which  were  already  flourish- 
ing in  the  isle  of  Cos,  under  the  successors  of  Hippocrates,  received 
a  new  impulse  by  the  foundation  of  the  school  at  Alexandria,  and  sud- 
denly attained  in  that  city  a  degree  of  prosperity  unheard  of  before. 
We  have  pointed  out  some  of  the  circumstances  which  concurred  to 
this  happy  revolution ;  such  as  the  formation  of  a  great  library,  and  a 
museum  of  natural  history,  open,  if  not  to  the  public,  at  least  to  all 
professional  men  who  fixed  their  residence  in  the  capital  of  Egypt ; 
the  influence  of  the  learned,  drawn  to  that  capital  by  the  honors, 
rewards,  and  especially  the  perspective  of  an  easy  and  secure  life; 
finally,  the  dissection  of  the  kuman  body,  which  could  nowhere  else 
be  practiced  openly  without  peril,  was  not  only  authorized,  but  even 
encouraged  by  the  sovereigns,  who  were  above  the  prejudices  of  the  a^e. 
By  this  union  of  circumstances,  the  school  of  Alexandria  became  the 
most  famous  in  the  world,  for  natural  and  medical  sciences ;  and  though 
the  Roman  invasion  cut  ofi^  a  part  of  the  advantages  which  it  enjoyed, 
it  still  held  the  first  rank. 

During  the  historic  period  that  we  have  just  passed  over,  anatomy 
and  physiology  made  the  most  progress ;  next  followed  internal  and 
external  nosography  ;  lastly,  medical  and  surgical  therapeutics  accjuired 
great  perfection.     Two  works  on  Internal  Nosography,  that  of  Aret£eus,t 


^  Whatever  yet  remains  of  vague  and  indecisive,  in  the  expression  of  our 
thoughts  concerning  the  ancient  systems  of  Medicine,  will  completely  disappear, 
when  we  shall  have  exhibited  the  modern  systems  which  are  derived  from  them  : 
because,  then,  we  shall  better  know  the  real  origin  of  the  ideas  and  the  mode  of 
formation  of  the  physical  sciences. 

t  Aretaei  Cappadocis,  De  Causis  et  Signis  Acutorum  et  Diuturnorum  libri. 
nova  editio,  Graece  et  Latine  cum  notis  Kuhn,  Lipsite,  1828,  in  8vo. 


236  ANATOMICAL   PERIOD. 

and  that  of  Coelius  Aurelianus,--'  have  left  far  in  the  rear  all  that  the 
preceding  period  has  transmitted  to  us  on  this  branch  of  science  ;  never- 
theless, the  medical  fame  of  no  one  of  that  period  has  reached  the  hight 
of  that  of  Hippocrates  ;  no  man  united  in  himself,  perhaps,  in  the  same 
degree  as  he,  all  those  qualities  that  constitute  the  great  practitioner  — 
intelligence,  sincerity,  disinterestedness,  the  love  of  his  Art,  and  of 
humanity. 

In  regard  to  theory,  Medicine  made  also  remarkable  progress.  Instead 
of  a  few  general  considerations,  and  a  few  incomplete  essays  at  system- 
ization,  met  with  in  the  Hippocratic  writings,  the  present  period  offers  us 
complete  systems,  whose  parts,  closely  co-ordinated,  are  more  or  less  well 
adapted  to  the  various  forms  of  diseases,  and  practical  details.  Dog- 
matism, enlarged  and  improved,  represents,  as  exactly  as  possible,  the 
combined  influence  of  the  vital  principle,  or  organic  forces,  with  the 
properties  of  the  physico-chemical  elements,  or  general  forces.  Empi- 
ricism laid  the  foundation  of  a  new  scientific  edifice ;  an  edifice  which 
it  not  only  left  unfinished,  but  of  which,  also,  it  did  not  perceive 
the  definite  end.  Methodism,  which  should  have  been  contented  with 
indicating  this  end,  in  accepting  the  experimental  contributions  fur 
nished  by  Empiricism,  rejected  these,  and  flattered  itself  to  be  able  to 
construct  a  medical  edifice  by  commencing  at  the  summit — that  is  to 
say,  with  the  general  properties  of  matter.  It  seduces,  by  an  appear- 
ance of  simplicity  and  rigorous  exactness,  but  in  fact  constitutes  only 
an  ideal  monument,  which  falls  before  the  result  of  daily  observation 
and  practice.  The  Eclectic,  not  perceiving  in  any  of  these  systems  the 
truth  in  full,  and  seeing  that  none  of  them  embraced  the  plenitude  of 
science,  but  only  a  part — one  aspect — refused  to  all  his  adhesion,  and 
boasted  of  choosing  from  each  what  he  considered  best.  Nevertheless, 
he  does  not  define  in  what  this  consists  ;  he  gives  no  rule  by  which  it 
can  be  known  ;  he  refers  to  the  reason  and  experience  of  each  one,  i.  e., 
he  proclaimed  individualism,  doubt,  and  isolation.  In  the  midst  of  this 
conflict,  Dogmatism,  resting  on  the  highest  philosophical  and  medical 
illustrations,  developed  and  sustained  by  the  immense  erudition  and 
subtile  dialectics  of  Galen,  offers  the  most  extended  and  reasonable 
explanation  of  the  phenomena  of  the  living  economy.  It  thus  must 
triumph,  as  in  fact  it  did,  its  errors  even  contributing  to  establish  it ; 
for  they  were  in  harmony  with  the  prejudices  of  the  dominant  philo- 
sophy. 

"  Coelius  Aurelianus,  De  Morbis  Acutia  et  Chronicis,  nova  editio,  Amst., 
1709,  in  4to. 


BOOK     II. 
AGE    OF    TRANSITION. 

J0M:MEN€ING  at  the  death  of  GALEN,  DURING  THE  REIGN  OF 
THE  EMPEROR  SEPTIMUS  SEVERUS,  A.  D.  201,  AND  ENDING  AT 
THE  REVIVAL   OF  LETTERS  IN   EUROPE,   ABOUT   THE    YEAR   1400. 


V.    GREEK   PERIOD. 

SNCLUBING  THE  PERIOD  OP  TIME  BETWEEN  THE  DEATH  OF  GA.LEN  AND  THE 
DESTRUCTION  OF  THE  ALEXANDRIAN  LIBRARY,  WHICH  OCCURRED  IN  THE 
YEAR  64a 


GENERAL     CONSIDERATIONS. 

At  the  time  when  this  historic  period  oommences,  all  the  known 
parte  of  the  ancient  world  were  under  the  dominion  of  a  single 
man.  The  empire  of  Septimus  Severus  had  more  extent  than  that  of 
Alexander  the  Greai,  and  inspired  the  hope  of  a  much  longer  existr- 
ence.  The  Eoman  dominion,  cemented  by  seven  hundred  years  of  a 
skillful,  bold,  and  persevering  government,  appeared  seated  on  immov- 
able foundations.  The  people  of  the  adjoining  frontiers  troubled  yet, 
occasionally,  the  peace  of  this  vast  territory,  but  none  were  strong  enough 
to  penetrate  as  far  as  its  center,  and  place  this  gigantic  power  in  any 
real  peril. 

The  great  civil  wars  had  ceased,  or  had  changed  their  object.  The 
people  and  the  Senate,  those  two  eternal  competitors,  no  longer  contended 
for  supreme  power ;  they  had  both  given  over  the  struggle.  The  monar- 
chical form  was  now  accepted,  not  only  ss  a  fact,  but  as  a  habit  and  a 
necessity.  The  citizens  no  longer  took  up  arms  to  change  the  form  of 
government,  but  only  for  the  choice  of  a  master. 

A  revolution  is  progressing  in  the  domain  of  the  mind,  analogous  to 
tihat  which  had  changed  the  political  world.  The  discussions  of  the 
philosophers,  so  interesting  in  the  schools  of  Greece,  where  the  most 


238  GREEK   PERIOD. 

difficult  questions  in  physics,  morals,  and  metaphysics  were  discussed  in 
full  liberty,  have  already  lost  much  of  their  interest,  and  very  soon  will 
cease  entirely.  The  supremacy  of  one  tends  to  be  established  in  the 
whole  intellectual  world.  The  disputes  relate  but  little  to  principles, 
but  rather  to  the  true  meaning  of  the  language  of  the  teacher.  In 
morals,  Plato,  Epicurus,  and  Zeno  are  followed,  until  a  purer  and 
more  sublime  morality,  that  of  Jesus,  son  of  Mary,  takes  the  place  of 
all  the  rest.  In  physics  and  metaphysics,  Aristotle  soon  reigned  des- 
potic, and  the  authority  of  Galen  is  unrivaled  in  Medicine. 

History,  which  should  be  the  faithful  image  of  society,  becomes  con- 
tracted, also,  during  this  age,  justly  called  the  age  of  transition,  because 
it  serves  as  a  transition  from  one  social  state  to  another.  In  place  of 
offering  the  scene  of  great  contests  and  movements,  it  is  summed  up  in 
some  sort  in  the  biographies  of  individuals — in  interior  manifestations ; 
and,  to  keep  to  our  special  subject,  we  will  say,  that  the  history  of 
Medicine  will  no  longer  be  taken  up  with  discussion  among  various 
sects,  and  of  choice  between  different  methods ;  for  there  is  now,  and 
will  be  for  ages,  but  one  sect  and  one  sole  method.  The  progress  of 
medical  science,  slowly  retrograding,  will  no  more  be  thwarted  by  any 
remarkable  revolution ;  only,  the  scientific  scepter  will  pass  from  the 
hands  of  one  nation  to  that  of  another,  and  the  language  of  Hippocra- 
tes and  Galen  will  be  replaced  by  that  of  Avicenna  and  Albucasis. 

The  first  period  of  the  age  of  transition  offers  for  our  consideration, 
Dnly  the  lives  and  writings  of  four  Greek  physicians,  all  of  whom  had 
studied  in  the  school  of  Alexandria,  and  whose  reputations  were  sus- 
tained until  the  time  of  the  invasion  of  the  Arabs.  Though  these 
writers  had  made,  for  the  most  part,  only  a  compilation  of  the  works 
of  Galen  and  other  authors,  they  have  rendered,  nevertheless,  a  signal 
service  in  presenting  science  under  an  abridged  and  more  commodious 
form,  and  in  enriching  it  with  several  new  particulars,  and  especially 
in  preventing  its  torch  being  extinguished  among  their  indolent 
cotemporaries. 


CHAPTEK    I. 
CELEBRATED  COMMENTATORS. 


Oribasius  is  the  first  author  of  any  importance  in  the  history  of 
Medicine,  after  Galen.  He  was  also  born  at  Pergamos,  and  lived  in 
the  fourth  century.  He  attached  himself,  early,  to  the  fortunes  of 
Julian,  surnamed  the  Apostate,  and  followed  him  into  Gaul,  when  that 


CELEBRATED   COMMENTATORS.  239 

prince  was  named  its  governor.  He  recalls,  himself,  this  circumstance, 
in  the  preface  to  one  of  his  works.  The  young  Caesar  appreciated  the 
great  qualities  of  Oribasius,  and  became  very  intimate  with  him,  and 
after  he  was  made  emperor,  appointed  him  Questor  at  Constantinople. 
After  the  premature  death  of  that  philosophic  ruler,  Oribasius  remained 
faithful  to  his  memory,  but  those  who  were  envious  of  him,  falsely  rep- 
resented his  fidelity.  He  was  disgraced,  spoiled  of  his  office  and  his 
property,  and  banished  among  a  barbarous  people.  The  courage  which 
he  displayed  on  that  occasion,  the  extraordinary  cures  that  he  effected, 
the  eloquence  of  his  discourses,  attached  to  him  very  soon  the  love  and 
respect  of  semi-savage  men,  who  wished  to  honor  him  as  a  god.  The 
fame  of  the  homage  he  received  reached  the  ears  of  the  emperors  Valens 
and  Yalentinianus.  They  saw  their  error,  recalled  Oribasius,  reimbursed 
him  for  his  losses  in  his  property  and  dignities,  and  permitted  him  to 
enjoy  peaceably  to  the  end  of  his  days,  his  high  reputation  and  fortune. 
Eunapius,  a  cotemporary  of  Oribasius,  and  a  physician,  gives  a  very  flat- 
tering account  of  him.  He  was,  he  says,  the  wisest  man  of  his  time  ; 
the  most  skillful  in  Medicine,  and  the  most  amiable  in  conversation. 

Oribasius  has  written  several  works,  of  which  the  most  important, 
entitled  Collections  Medicinales,  was  dedicated  to  Julian,  when  he  was 
only  as  yet  Csesar.  It  includes  seventy  books,  of  which  seventeen  only 
have  reached  us.  The  following  passages,  forming  the  preface,  exhibit 
for  what  end,  and  in  what  spirit  the  work  was  undertaken. 

"  I  have  finished  long  since,  divine  Csesar,  the  abridgement  of  the 
books  of  Galen,  which  you  charged  me  to  make,  during  our  residence  in 
the  nearer  Gaul.  You  deigned  to  express  your  satisfaction  on  the  sub- 
ject, and  you  enjoined  upon  me,  at  the  same  time,  another  work — that 
of  reducing  to  a  single  volume,  all  that  the  most  illustrious  physicians 
have  taught,  of  utility,  on  the  Healing  Art.  I  have,  there^^re,  resolved 
to  gratify  you  according  to  my  abilities.  I  shall  be  careful  to  omit 
nothing  of  what  Galen  had  said,  because  he  is,  of  all  those  who  have 
written  on  these  matters,  the  one  who  has  treated  his  subject  with  most 
clearness,  reason,  and  method.  He  shows  himself,  besides,  the  faithful 
interpreter  of  the  principles  and  sentiments  of  Hippocrates." 

Oribasius  edited,  at  a  later  period,  an  abridgment  of  his  great  work, 
for  the  benefit  of  his  son.  This  abridgment,  divided  into  nineteen  books, 
has  reached  us  complete,  as  well  as  another  compendium,  on  the  prepa- 
ration of  remedies  and  the  cure  of  diseases,  undertaken  at  the  solicita- 
tion of  his  friend  Eunapius. 

This  writer,  as  is  seen,  does  not  hesitate  to  avow  that  he  borrows 
from  the  authors  that  have  preceded  him,  and  particularly  from  Galen, 
the  greater  part  of  his  materials.     Nevertheless,  there  are  in  his  books. 


240  GREEK   PERIOD. 

certain  fragments  which  are  no  where  else  found ;  but  we  are  ignorant, 
whether  they  are  his  own,  or  borrowed  from  some  authors  whose  works 
are  lost ;  for  he  cites  several,  whose  works  are  entirely  lost,  such  as 
Herodotus,  chief  of  the  pneumatic  sect,  Archigenes,  Posidonius,  and 
Antyllus.  However  this  may  be,  his  principal  merit  consists  in  repro- 
ducing the  ideas  of  others  with  so  much  clearness,  order,  and  precision, 
that  the  summaries  he  has  given  of  them  are  often  preferable  to  the 
originals  themselves.  What  he  has  said  of  px'egnant  women,  nurses,  and 
the  earliest  education  of  the  child,  has  appeared  so  perfect  to  the  writers 
that  have  followed  him,  that  the  most  of  them  have  copied  him  literally, 
to  the  beginning  of  fifteenth  century.  We  shall  quote  an  example  of 
this  in  speaking  of  Paulus  J^gineta. 

Oribasius  has  written  very  little  concerning  surgery,  but  he  is  much 
more  extended  on  anatomy,  on  which  he  follows  Galen  exclusively.  His 
prepossession  in  favor  of  the  latter  is  so  great,  and  he  makes  of  it  so 
little  concealment — he  adopts  so  servilely,  his  theoretic  idea,  even  to  his 
expressions — that  he  has  been  surnamed  the  ape  of  Galen. 

§11. 

Aetius  flourished  towards  the  close  of  the  fifth  century,  and  in  the 
commencement  of  the  sixth.  He  was  born  in  the  city  of  Amida,  in 
Mesopotamia,  and  studied  medicine  at  Alexandria,  as  we  learn  from 
him.  He  went  afterwards  to  Constantinople,  where  he  was  attached  to 
the  court,  with  the  grade  of  Count  of  the  Palace,  or  chamberlain. 
Aetius  appears  to  have  been  the  first  physician  of  any  note,  who  pro- 
fessed Christianity.  The  following  passages  leave  no  doubt  as  to  his 
religion,  but  they  show,  at  the  same  time,  that  his  faith  was  more 
enthusiastic  than  enlightened.  In  stating  the  composition  of  a  certain 
ointment,  he  recommends  that  the  following  words  be  repeated  in  a  low 
voice :  "  may  the  God  of  Abraham,  the  God  of  Isaac,  and  the  God  of 
Jacob,  deign  to  bestow  upon  this  medicament,  such  and   such  virtues." 

In  another  place,  he  recommends,  that  to  extract  a  bone  from  the 
throat  the  following  words  be  pronounced :  "  bone,  as  Jesus  Christ  caused 
Lazarus  to  come  forth  from  the  sepulchre,  as  Jonah  came  out  of  the 
whale's  belly,  come  out  of  the  throat;"  or  in  this  form:  "bone,  I  con- 
jure you,  by  Blaises,  martyr  and  servant  of  Jesus  Christ,  come  forth,  or 
go  down."  He  exhibits  the  same  credulity  in  not  doubting  the  miracu- 
lous virtues  attributed  by  the  charlatans  of  his  age,  to  a  mass  of  their 
remedies. 

Nevertheless,  this  author  recommends  himself  to  us  in  the  same  way 
as  Oribasius.  Like  him,  he  has  collected  all  that  he  has  found  remark- 
able in  the  writings  of  his  predecessors,  and  has  instituted  a  body  of 


CELEBRATED   COMMENTATORS.  241 

doctrines,  in  such  a  way  as  to  omit  nothing  essential.  We  are  indebted 
to  him,  for  the  preservation  of  several  fragments  of  antiquity,  which 
otherwise  would  have  been  entirely  lost.  His  work,  divided  into  four 
sections,  of  four  books  each,  formed  a  complete  manual  of  medicine  and 
surgery,  except  that  it  lacked  anatomical  descriptions,  and  what  relates 
to  luxations  and  fractures.  His  surgery  consisted  of  external  applica- 
tions only.  He  points  out  the  composition  of  a  multitude  of  plasters 
and  ointments,  and  recommends  the  frequent  use  of  the  cautei'y,  both 
actual  and  potential.  In  his  materia  medica,  the  remedies  are  arranged 
according  to  the  kingdom  to  which  they  belong,  and  in  alphabetical 
order;  but  he  does  not  describe,  like  Dioscorides,  the  natural  characters 
of  the  substances  ;  having  been  content  to  enumerate  their  medicinal 
properties,  in  which  he  adopts  the  ideas  of  Galen. 

§ni. 

Alexander  was  of  Tralles,  a  city  of  Lydia,  where  the  Greek  language 
was  very  correctly  spoken.  His  father  Stephen,  like  himself,  a  physi- 
cian, had  five  sons,  whom  he  carefully  educated,  and  who  were  all  dis- 
tinguished for  their  learning ;  but  Alexander  was  the  most  celebrated 
of  his  family.  After  having  traveled  in  many  parts  of  Asia,  Egypt, 
Spain,  Gaul,  and  Italy,  he  fixed  his  residence  at  Eome,  where  he  imme- 
diately acquired  a  brilliant  reputation.  Living  to  a  very  advanced  age, 
and  being  no  longer  able  to  sustain  the  fatigues  of  practice,  he  was  still 
willing  to  be  useful  by  giving  to  the  public  the  fruits  of  his  long  expe- 
rience. To  this  end,  he  composed  a  treatise  in  twelve  books,  exclusively 
devoted  to  afiections  that  do  not  require  the  aid  of  surgery.  The  first 
ten  books  treat  of  diseases  of  a  special  seat,  commencing  with  those 
of  the  head,  and  finishing  with  those  of  the  abdomen.  The  eleventh 
treats  of  gout  alone,  and  the  twelfth  of  fevers.  It  seems,  nevertheless, 
the  last  should  be  placed  the  first,  and  such  was  the  intention  of  the 
author,  as  expressed  in  his  preface. 

"  Since  you  desire,"  says  he,  "dear  Cosme,  that  I  inform  you  of  the 
remedies  whose  efficacy  I  have  frequently  proved  in  diseases,  I  feel 
impressed  to  acquiesce  in  your  request,  on  remembering  the  kindness 
with  which  you  and  your  father  have  honored  me.  I  feel  myself  happy 
in  having,  in  my  old  age,  this  occasion  to  gratify  you,  and  since  I  can 
no  longer  support  its  fatigues,  I  have  resolved  to  embody  here,  succinctly, 
the  knowledge  I  have  acquired  in  a  long  practice.  I  hope  that  those 
who  shall  read  this  book  without  prejudice,  will  be  charmed  by  the  exact- 
ness of  my  teachings,  and  the  clearness  and  conciseness  of  my  style.  I 
have  studied  to  employ,  as  much  as  possible,  common  and  usual  terms, 
so  as  to  have  ray  diction  comprehended  by  the  vulgar  even.     We  shall 


242  GREEK   PERIOD. 

commence  with  ephemeral  fevers,  following  the  method  of  the  divine 
Galen,  to  whom  we  shall  endeavor  to  conform  in  this,  as  in  everything 
else." 

We  see  by  the  above  that  he  professes,  after  the  example  of  his  pre- 
decessors, a  great  veneration  for  Galen ;  but  he  does  not  adopt,  like 
them,  his  opinions  blindly,  at  least  in  regard  to  practice.  He  allows  him- 
self, at  times,  to  take  an  opposite  view,  not,  he  says,  from  a  desire  to 
contradict  so  great  a  man,  but  with  a  wish  to  present  things  in  their 
true  light;  and  though  he  makes  no  innovation,  in  a  theoretical  point 
of  view,  yet  we  place  him  in  the  same  category  as  the  two  compilers  of 
whom  we  have  just  spoken.  From  the  manner  in  which  he  describes 
diseases  and  directs  the  treatment,  we  regard  him  as  a  good  observer.  He 
speaks  of  several,  of  which  no  one  before  him  has  made  mention.  Such, 
among  others,  is  the  case  of  a  woman  tormented  by  excessive  hunger, 
called  bulimia — a  perpetual  gnawing  in  the  stomach,  accompanied  with 
a  violent  pain  in  the  head.  This  woman  was  cured  by  taking  iera, 
which  caused  her  to  pass  a  worm  twelve  cubits  in  length.  This  is  the 
first  time  that  a  condition  of  this  kind  was  attributed  to  intestinal 
worms.  He  advised  bleeding  in  the  foot  in  hemoptysis,  and  he  says 
that  he  found  it  more  efficacious  than  at  the  arm ;  because,  he  adds, 
performed  thus  distinct  from  the  diseased  part,  it  acts  as  a  powerful 
revulsive.  No  better  reason  could  be  offered  now,  even,  for  a  similar 
course.  In  tertian  fevers,  more  particularly  than  in  the  quartan,  he 
was  accustomed  to  procure  vomiting  before  the  accession,  and  affirms 
that  he  obtained  great  success  in  this  way.  We  conceive  that  it  must 
have  been  one  of  the  most  efficacious  remedies,  before  the  discovery  of 
the  febrifuge  par  excellence.  But  what  is  most  difficult  to  conceive,  and 
which  at  the  same  time  astonishes  and  afflicts  us,  is,  that  a  man  of 
judgment  so  sound,  and  a  mind  so  enlightened,  had  faith  in  the  virtue 
of  amulets  and  talismans,  the  use  of  which  he  recommends  on  various 
occasions.  Such  was  the  universal  prejudice  of  his  age,  that  it  was 
necessary  for  every  man  to  pay  tribute  to  the  errors  of  his  cotempora- 
ries.  Alexander  has  at  least  this  excuse,  that  the  whole  world  in  his 
time  was  plunged  in  the  same  superstition ;  and  we  shall  see,  that  up 
to  an  epoch  very  near  our  own,  physicians  of  reputation,  and  learned 
men,  partook  of  this  weakness  without  having  the  same  excuse. 

Without  pretending  to  place  this  author  in  parallel  with  Aretoeus  of 
Cappadocia,  there  exist,  nevertheless,  some  traits  of  resemblance,  which 
unite  them.  In  the  first  place,  they  have  both  treated  of  a  small  num- 
ber of  diseases,  only  about  sixty,  which  proves  that  they  were  only  will- 
ing to  speak  of  those  they  had  seen  and  studied.  Their  plan  of  arrange- 
ment is  similar,  and  is  the  most  natural  that  could  have  been  adopted 


CELEBRATED   COMMENTATORS.  243 

in  their  times.  They  were  equally  exact  in  describing  the  symptoms 
of  diseases,  and  in  tracing  out  the  characteristic  signs  of  those  which 
are  most  likely  to  be  confounded,  on  account  of  their  similarity.  Though 
the  style  of  Alexander  is  much  less  elegant  and  pure  than  that  of  the 
physician  of  Cappadocia,  it  closely  resembles  it  in  clearness,  concise- 
ness, and  energy.  There  is  also  this  diflPerence  between  them :  Alex- 
ander does  not  give  an  anatomical  description  of  the  affected  parts  in 
each  disease.  But  the  reader  himself  shall  be  able  to  make  the  com- 
parison, by  placing  the  following  description  in  comparison  with  that 
which  has  been  given  on  a  previous  page. 

"  I  do  not  give  the  name  pleurisy,"  says  Alexander,  "  to  every  species 
of  pain  in  the  side,  for  true  pleurisy  is  the  inflammation  of  the  mem- 
brane which  lines  the  chest.  It  is  accompanied  with  an  acute  fever, 
which  is  owing  to  the  proximity  of  the  heart,  which  suffers  sympatheti- 
cally. If,  then,  you  observe  in  a  sick  person,  a  difficult  respiration, 
with  acute  fever,  cough,  and  pungent  pain,  you  may  be  sure  that  he  is 
a  true  pleuritic.  Those  who  are  affected  with  an  inflammation  of  the 
liver  have  also  a  fever,  and  breathe  with  pain  ;  their  side  is  also  tender 
and  painful,  and  they  have  a  sympathetic  cough  ;  but  the  stitch  in  the 
side,  and  the  hardness  of  pulse  are  absent. 

"  The  following  is  the  rule  by  which  to  distinguish  pleurisy  from 
hepatitis:  they  are  distinguished,  particularly,  in  the  nature  of  the 
pain,  and  the  character  of  the  pulse.  The  pleuritics  have  a  hard  pulse, 
which  gives  to  the  touch  the  sensation  of  a  saw  ;  it  is  not  the  same  in 
persons  affected  with  hepatitis,  nor  do  pulmonics  experience  anything 
similar,  on  account  of  the  softness  of  the  affected  organ.  The  cough  is 
also  different  in  pleurisy  from  that  in  hepatitis.  In  the  former,  it  is 
more  violent,  and  is  promptly  followed  with  expectoration.  During  the 
progress  of  the  disease  the  color  of  the  expectorated  substance  indicates 
what  humor  it  is  which  has  given  rise  to  the  inflammation.  Eed  matter 
shows  that  it  comes  from  the  blood  ;  yellow,  from  the  bile  ;  that  which 
is  white  and  viscid  announces  the  phlegm  ;  dark,  the  atrabile.  In 
hepatitis,  there  is  cough,  but  no  expectoration.  Eemember,  though- 
that  in  pleurisy,  sometimes,  there  is  no  expectoration ;  from  which  it 
follows,  that  it  would  be  wi'ong  to  consider  as  a  hepatitic,  every  indi- 
vidual who  coughs  without  expectorating  ;  for  there  are  obstinate  pleu- 
risies, of  difficult  coction,  and  these  are  the  most  dangerous.  The  inflam- 
mation may  also  be  seated  below  the  false  ribs,  without  extending  into 
the  chest ;  it  may  also  be  exterior.  In  these  cases  there  can  be  no 
expectoration ;  but,  then,  the  humors  which  cause  the  inflammation 
form  an  abscess,  unless  it  is  discussed,  which  rarely  happens.  Give, 
then,  attention  to  all  these  signs,  as  well  as  to  the  color  of  the  face. 


244  GREEK   PERIOD. 

Patients  attacked  with  hepatitis  are  usually  pale ;  it  is  the  opposite 
with  those  who  have  pleurisy.      In  this  way  you  may  discern  the 

latter."- 

§IV. 

Paul,  surnamed  iEgineta,  because  he  was  a  native  of  the  isle  of  Mgina., 
is  the  last  Greek  physician  who  will  interest  us.  Though  the  time  in 
which  he  lived  is  somewhat  uncertain,  the  most  probable  opinion  places 
it  toward  the  end  of  the  sixth  century,  and  the  first  half  of  the  seventh. 
He  travelled  much,  and  doubtless  spent  some  time  in  Alexandria,  either 
to  gain  instruction  in  his  Art,  or  to  teach  it.  His  skill  in  surgery,  and 
especially  in  obstetrics,  rendered  him  celebrated,  even  among  the  Arabs, 
whose  midwives  sent  for  him  in  consultation,  it  is  said,  from  great  dis- 
tances, in  difficult  cases.  On  this  account  their  writers  frequently  give 
him  the  surname  of  accoucheur ;  which  does  not  signify  that  he  limited 
himself  to  that  branch  specially,  in  surgery,  but  that  he  had  acquired 
in  it  a  great  reputation,  and  rendered  himself  celebrated. 

Paul  of  iEgina  composed  a  compendium  of  Medicine,  divided  into 
seven  books  ;  after  the  example  of  others,  he  does  not  hesitate  to  borrow 
from  his  predecessors,  or  even  to  copy  them  literally.  A  number  of 
chapters  can  be  cited,  taken  entirely  from  Oribasius,  and  especially 
those  that  concern  pregnant  women,  and  the  earliest  life  of  infants.  I 
will  content  myself  by  placing  an  example  of  this  before  the  eyes  of  the 
reader,  so  that  he  may  judge  for  himself  the  manner  in  which  authors 
of  those  times  plundered  their  predecessors. 

-ORIBASII  SYNOPSEOS.  PAULI  iEGINET^. 

LIBER    QUINTUS.  LIBER    PRIMUS. 

CAP.   V.  CAP.    V. 

Educatio  pueruli.  Educatio  pueri. 

Puer  nuper  in  lucem  editus  xnelle  Priraum  alimentum  recens  nato  in- 

primiim  nutriator;  deinde  lacte  bis  in  fanti  mel  exhibere  oportet ;  posteavero 

die,  aut  ter  ad  summum.     Quiimque  id  lac  praebere  bis  in  die,  aut  ad  summum 

alacriter  puer  assumit,  spesque  est  cum  ter.     Quuiii  autem  et  ipse  promptus 

esse  concocturum,  turn  cibus  jam  offeri  fuerit  ad  accipiendum,  et  spem  exhib- 

potest  qui  ipsum  non  impleat:  si  vero  ueritconcoctionis,  tunc  jam  etiam  cibus 

nobis  ignaris  impleatur,  turn  ad  som-  dandus  est  qui  non  impleat.     Si  vero 

num  proclivior  et  segnior  efficitur,  ven-  nobis  non  advertentibus  repleti  fuerint, 

terque  intumescit  et  inflatur,  et  urina  somnolentiores    statim    et     segniores 

redditur  aquosior :    quibus   notis   per-  fiunt,  et  tumor  in  ventre  adest  et  fla- 

spectis,  nihil  dandum   est   priusquam  tus,  et  urina3  sunt  aquosiores.     Ex  qui- 

quod    in   ventre   habet   consumpserit.  bussignisrepletionedcpreliensa,  nutrix 

Satis  erit  biennium  lacte  nutrire ;  de-  nibil  exhibere  debet,  donee  fuerit  con- 

inde  vero  ad  cibos  transeundudum  est.  sumpta.     Sufficit  autem  biennium  lacte 

nutrire ;  deinde  ad  cibos  transgredi. 

"'  De  Arte  Medica,  lib.  vi,  cap.  i. 


MEDICAL  ORGANIZATION.  245 

But  Paul  of  JEginn  makes  no  secret  of  this  course,  which  saves  him 
from  the  reproach  of  plagiarism.  "While  it  would  be  extremely  diffi- 
cult, not  to  say  impossible,  to  retain  in  the  memory  the  general  principles 
of  the  Healing  Art,  and  all  the  particular  means  advised  by  the  ancients 
I  have  made  this  abridgement  of  what  there  is  best  of  their  writings. 
They  are  not  my  own  conceptions  which  I  propose,  if  exception  be  made 
of  some  details  of  observation  noted  in  my  practice ;  but,  being  versed 
in  the  reading  of  a  number  of  excellent  authors,  and  principally  Oriba- 
sius,  I  have  attempted,  in  imitation  of  him,  to  collect  the  cream  of  what 
others  have  said  concerning  the  means  of  preserving  health." 

Notwithstanding  this  modest  avowal,  Paul  is  not  deficient  in  origin- 
ality. The  surgical  part  of  his  book  includes  a  quantity  of  observations 
which  are  his  own,  and  which  prove  that  he  had  performed  many  opera- 
tions ;  and  so  far  from  following,  always,  the  rules  of  others,  he  knew 
how  to  modify  them  according  to  circumstances,  and  to  extend  even  the 
narrow  limits  of  his  art.  He  is  often  more  explicit  than  Celsus,  whether 
in  the  description  of  diseases  and  the  curative  indications,  or  in  the 
exposition  of  a  plan  of  operations.  I  will  refer,  among  others,  to  the 
chapters  relative  to  hydrocephalus,  paracentecis  of  the  thorax  and  abdo- 
men, the  extraction  of  vesicular  calculi,  and  aneurisms.  He  is  the  first 
who  pointed  out  and  described  varicose  aneurisms ;  the  excision  of  hyper- 
tophied  mammse  in  men,  etc.  He  appears  also  to  have  been  the  first  to 
perform  the  operation  of  bronchotomy,  after  a  method  which  he  borrowed 
from  Antyllus,  of  which  he  has  transmitted  us  a  very  detailed  account. 
I  will  close  what  concerns  this  author,  by  the  single  remark,  that  Fabri- 
cius  of  Aquapendente,  the  famous  surgeon  of  the  sixteenth  century, 
draws  from  him  and  Celsus  the  basis  of  his  doctrines. 


CHAPTER  II. 

MEDICAL  ORGANIZATION. 

I  have  already  said  a  few  words  on  the  medical  organization  of  the 
most  celebrated  people  of  antiquity.  I  now  proceed  to  examine  this 
organization  in  a  more  special  manner.  I  shall  describe  the  principal 
changes  to  which  the  profession  of  Medicine  was  subjected,  in  proportion 
as  civilization  progressed,  from  the  infancy  of  society  to  the  ruin  of  the 
Alexandrian  school.  I  shall  speak  of  the  few  laws  that  regulated  its 
teaching  and  practice  in  remote  ages,  and  I  shall  show  the  origin  of 
some  institutions  destined  to  extend  the  benefits  of  the  Healing  Art  to 
the  inferior  classes  of  society. 


246  GRSEK  PERIOD. 

I  have  put  off,  to  the  end  of  this  period,  what  I  have  to  say  on  this 
subject,  so  as  to  bring  together,  in  a  single  view,  everything  that  relates 
to  it.  By  the  aid  of  this  concentration,  the  reader  will  be  able,  at  one 
glance,  to  compare  among  themselves  the  various  phases  of  the  medical 
profession,  throughout  antiquity ;  for  the  extinction  of  the  Greek  domi- 
nation in  Egypt  constitutes,  in  the  history  of  Medicine,  the  separation 
of  ancient  from  modern  times.  At  that  epoch,  a  new  language  and  new 
authors  made  their  appearance  in  the  medical  world — the  scepter  of 
letters  and  arts  passed  from  the  Greeks  to  the  Arabs — and  then  com- 
menced a  new  era. 

If  a  general  view  be  taken  of  the  organization  of  medicine  among  the 
ancients,  four  distinct  phases  may  be  recognized ;  each  of  which  corres- 
ponds to  a  form  and  particular  state  of  civilization. 

FIRST   PHASE. 

At  the  origin  of  society,  among  the  wandering  tribes  and  small  set- 
tlements, before  the  existence  of  great  cities,  and  especially  before 
the  invention  of  writing,  the  treasury  of  human  knowledge  was  very 
limited,  and  the  memory  of  one  man  sufficed  to  contain  it.  It  was 
composed  of  a  few  simple  notions  which  wei'e  transmitted,  verbally, 
from  father  to  son — from  the  master  to  the  disciple — and  formed,  often, 
the  patrimony  of  a  family.  At  this  epoch,  the  same  person  often  united 
in  himself  the  authority  of  sovereign,  priest  and  man  of  science. 

Such  were  the  patriarch  Jews,  Abraham,  Isaac,  and  Jacob,  and  those 
whom  Homer  paints  as  the  heroes  of  Greece — Kercules,  Theseus,  Jason, 
Achilles,  Ulysses,  etc.  We  see  them  after  the  combat,  sometimes,  dress- 
ing the  wounds  of  their  companions  in  arms,  or  preparing  them  a 
repast,  or  a  sacrifice,  or  a  funeral  ceremony.  We  have  before  remarked 
that  Machaon  and  Podalirius,  surnamed  the  sons  of  Esculapius,  on 
account  of  their  surgical  skill,  were  at  the  same  time  distinguished 
captains,  and  that  most  of  the  generals  who  served  at  the  siege  of 
Troy,  boasted  of  having  been  the  pupils  of  the  centaur  Chiron,  renowned 
for  his  great  skill  in  Medicine. 

We  know,  also,  that  the  Egyptians  attributed  the  invention  of  the 
Healing  Art,  and  all  other  arts,  to  several  of  their  kings ;  but  chiefly 
to  Hermes,  who  was  regarded  as  the  author  of  several  books  that  inclosed 
the  secrets  of  Medicine.  The  Chaldeans  attributed  the  honor  of  the 
same  discovery  to  Zoroaster ;  the  Chinese  to  Cinningo  and  Hohanti. 
In  a  word,  we  find  the  same  tradition,  with  but  slight  variations,  among 
all  the  famous  nations  of  antiquity,  which  proves,  evidently,  that  the 
chiefs  of  the  people  were  nearly  all,  at  the  same  time,  priests  and  physi- 
cians.    We  shall  give  to  this  first  phase  of  the  medical  profession,  the 


MEDICAL  ORGANIZATION.  247 

name  of  patriarchal,  because  the  practice  of  Medicine  constitutes  a 
species  of  patronage  and  protection. 

SECOND   PHASE. 

When  the  tribes  or  settlements  had  become  nations,  industry  had 
made  progress,  and  intellectual  riches  were  increased  by  the  aid,  espe- 
cially, of  the  admirable  artifice  which  enables  us  to  fix  thought,  and 
to  give  a  visible  body  to  the  passing  word ;  then  the  treasure  of  human 
knowledge  could  no  longer  be  contained  in  the  memory  of  a  single  man, 
and  the  highest  function  of  society  could  no  longer  be  executed  by  one 
individual ;  then  a  division  was  made,  varying  according  to  numerous 
circumstances,  but  which  presented  this  remarkable  peculiarity,  that 
the  priesthood  and  the  practice  of  Medicine  remained  a  long  time  united 
in  many  countries. 

It  was  so  in  Egypt,  when  the  priests  of  the  time  of  Moses  practiced 
Medicine,  and  all  the  learned  professions.  They  were  divided  into 
several  orders,  of  which  each  received  only  the  species  of  instruction 
appropriate  to  the  functions  he  professed  to  fulfil.  The  legislator  of 
the  Hebrews,  reared  among  the  priests,  introduced  the  greater  part  of 
their  institutions  among  the  Jews.  We  have  seen,  that  he  confided  to 
the  Levites  the  duties  of  religious  worship,  and  sanitary  police  or  public 
Medicine,  the  only  kind  that  is  alluded  to  in  his  laws.  In  Greece,  from 
the  ruin  of  Troy  to  the  dispersion  of  the  Pythagorean  society,  the  Ascle- 
piadae,  or  priests  of  Esculapius,  appear  to  have  been  the  only  physicians 
of  any  public  consideration.  Their  temples  were  transformed  into  dis- 
pensaries, where  patients  from  the  most  distant  countries  came  to  receive 
counsel  and  treatment.  The  same  phenomenon  is  reproduced  in  nearly 
all  countries  of  the  earth,  at  a  certain  epoch  in  civilization  ;  we  find  it 
in  the  history  of  the  ancient  Greeks  and  of  the  inhabitants  of  the 
Brittanic  Isles,  in  China  and  Japan,  among  the  Tartars,  in  Africa,  and 
in  the  New  World ;  we  see  the  same  in  Europe,  in  modern  times,  when 
feudal  anarchy  replaced  Roman  civilization. 

This  coincidence,  which  may  be  said  to  be  universal,  could  not  have 
been  the  result  of  accident ;  and  it  is  easy  to  explain,  by  a  little  reflec- 
tion, that  in  the  ages  of  ignorance,  credulity,  and  superstition,  diseases 
were  regarded  as  a  celestial  chastisement,  an  evidence  of  the  divine 
wrath,  or  as  the  result  of  some  malign  influence,  rather  than  as  the 
effect  of  natural  causes ;  and  therefore,  it  was  deemed  more  advisa- 
ble to  resort  to  prayers,  expiations,  sacrifices,  exorcisms,  etc. — as  much, 
at  least,  as  to  the  natural  resources  of  Medicine.  In  this  condition  of 
the  public  mind,  it  was  almost  inevitable  for  the  priests  to  take  hold  of 
the  practice  of  Medicine ;  for  they  shared,  also,  the  common  opinion, 


248 


GREEK   PERIOD. 


and  supposed  the  cure  of  diseases  a  part  of  their  attribute.  I  will 
therefore,  designate  this  phase  of  the  profession  by  the  epithet  of 
sacerdotal. 

THIRD   PHASE. 

Nevertheless,  the  clergy  did  not  always,  in  certain  countries,  remain 
in  exclusive  possession  of  the  secrets  of  Medicine.  There  came  a  time 
when  the  Art  was  no  longer  taught  in  an  occult  manner,  and  when  its 
practice  was  accessible  to  every  citizen.  That  revolution,  we  have  seen, 
first  took  place  in  Greece,  about  the  commencement  of  the  fifth  century 
before  Christ,  after  the  dispersion  of  the  Pythagoreans.  We  have 
appreciated  a  few  of  the  circumstances  that  accompanied  it ;  among 
others  the  promulgation  of  the  medical  doctrines  of  Cnidus  and  Cos. 
We  have  shown  how  the  families  that  had  the  direction  of  these  institu- 
tions, and  who  assumed  to  be  descendants  of  Esculapius,  acceding,  either 
willingly  or  unwillingly,  to  this  general  movement  of  mind,  divulged  the 
secrets  of  their  practice,  and  opened  the  schools  to  the  profane. 

It  is  probable  that  long  before  this  epoch  there  were  in  Greece,  as 
well  as  elsewhere,  individuals  not  adjuncts  to  the  priesthood,  who  pre- 
tended to  practice  Medicine.  These  were  medicasters  of  a  low  grade, 
herbalists,  holders  of  some  panacea  or  family  recipes  ;  but  these  were  not 
the  true  depositories  of  the  medical  science  of  their  time.  The  Asclepiadae 
alone  were  such,  and  they  made  no  communications  to  the  uninitiated. 
It  was  not  so  after  the  revolution  referred  to  ;  then  medical  science  fell 
within  the  public  domain,  and  to  be  admitted  to  the  profession  required 
only  leisure,  and  the  means  to  pay  for  books  or  teachers.  Science 
gained  very  much  by  this  transformation  ;  but  the  profession  was  much 
lowered  in  the  minds  of  the  people,  who  now  only  saw  it  in  the  light  of 
a  lucrative  occupation. 

From  Greece  this  revolution  was  extended  into  Asia  and  Egypt ;  it 
penetrated  Eome  about  the  time  of  the  second  Punic  war,  but  made 
little  progress  there  until  at  a  later  period,  by  the  talents  and  address 
of  Asclepiades  of  Bithynia.  Until  that  time  Medicine  had  been  prac- 
ticed at  Eome  under  the  patriarchal  form.  The  oldest  and  best 
instructed  of  the  relatives  treated  the  diseases  of  his  family,  as  he 
understood  them  ;  and  it  does  not  appear  that  the  priests,  more  than 
others,  assumed  this  function.  Cato,  the  censor,  was  much  engrossed 
with  this  domestic  Medicine.  He  wrote  a  book  on  the  subject,  in  which 
he  recommends  cabbage  as  a  sovereign  remedy  in  many  cases.  He 
venerated  the  number  three,  after  the  fashion  of  the  Pythagoreans,  and 
disdained  not  to  transmit  to  posterity  the  magical  words  which  he 
believed  were  useful  to  repeat  for  the  reduction  of  luxations  and 
fractures. 


MEDICAL  ORGANIZATION.  249 

If  this  practice  is  not  usually  the  most  enlightened,  or  the  most 
efficacious,  it  is  in  general  the  mildest  and  most  disinterested.  Besides, 
the  old  Censor  carried  to  the  end  of  his  life  a  profound  hatred  against 
the  men  of  the  medical  profession.  Let  us  see  in  what  terms  he 
endeavors,  by  his  familiar  correspondence,  to  inculcate  this  hatred  to 
his  son  Marcus.  '•  I  will  tell  you,"  he  writes,  "when  1  have  an 
opportunity,  what  I  think  of  these  G-reeks,  and  what  I  esteem  most  of 
what  there  is  in  Athens.  It  is  good  to  study,  to  some  extent,  their 
letters  and  sciences,  but  it  is  not  necessary  to  learn  them  fully.  I  shall 
be  done  with  this  wicked  and  proud  race ;  nevertheless,  be  assured,  as 
if  a  prophet  had  told  you,  that  as  soon  as  this  nation  shall  have  com- 
municated to  us  its  literature,  it  will  spoil  and  corrupt  everything,  and 
this  will  be  so  much  more  easily  eflFected  if  it  sends  us  also  its  physi- 
cians. They  have  sworn  among  themselves,  to  kill  all  barbarians  by 
means  of  medicine,  and  yet  they  require  pay  from  those  whom  they 
treat,  in  order  to  gain  their  confidence,  and  thus  ruin  them  more  easily. 
They  are  insolent  enough  to  call  us  barbarians,  as  well  as  others,  and 
they  treat  us  even  more  disdainfully,  by  calling  us  opiques.  In  short, 
remember  that  I  have  forbidden  you  to  employ  physicians."  =•' 

If  the  hatred  of  Cato  appears  to  be  blind  and  ridiculous,  like  every- 
thing which  is  exaggerated,  it  must  be  borne  in  mind  that  the  Greek 
physicians  who  came  to  Eome  merited,  in  part,  these  invectives.  The 
greater  number  were  only  intriguants,  without  instruction  or  manners, 
having  no  other  aim  than  to  make  a  fortune,  and  capable  of  every 
baseness  tc  attain  it.  Such  is  the  picture  that  Galen  has  drawn  of 
them,  as  we  have  shown  elsewhere.  Asclepiades  himself,  whose  superior 
talents  did  not  require  for  success  the  vile  deceits  of  charlatanism,  had 
recourse  to  these  shameful  means.  We  have  seen  that  he  promised  all 
his  patients  an  easy,  prompt,  and  perfect  cure,  and  I  now  add  another 
proposition  attributed  to  him :  "  whoever  understands  Medicine  thor- 
oughly is  never  sick."  Fortune,  it  is  said,  seemed  to  confirm  this 
aphorism  on  his  own  person,  for  he  reached  a  great  old  age,  and  died 
from  an  accident.  Such  an  example  never  lacks  imitators,  and  long  after 
Asclepiades,  Thessalus,  who  was  much  inferior  to  him  in  merit,  exhibited 
a  much  greater  amount  of  impudence.  He  would  only  appear  in  public 
accompanied  by  a  troop  of  bakers,  boys,  butchers,  weavers,  carders,  and 
other  artisans  of  the  lowest  classes  of  society,  to  whom  he  gave  the 
title  of  pupils,  whose  vulgar  language,  it  is  said,  he  used.  We  can 
conceive  the  stir  that  such  a  suit  must  have  made,  and  how  much  it 
served  to  increase  his  reputation  among  the  ignorant.     He  carried  his 

Cato,  De  re  rustica. 

16 


250  GREEK   PERIOD. 

audacity  so  far  as  to  write  to  the  Emperor  Nero,  that  previous  to 
himself,  no  physician  had  found  anything  certain  for  the  preservation 
of  health  and  the  cure  of  diseases,  and  that  he  alone  had  discovered 
the  true  method  of  treatment.  The  chronicle  reports  that  he  had 
extraordinary  success  ;  but  in  what  an  age  !  and  under  what  a  prince  ! 

The  number  of  these  false  physicians  was  much  more  considerable  at 
Eome  than  elsewhere.  Galen  has  indicated  the  reason  of  this  in  the 
following  passage  :  "  In  a  vast  and  populous  city,  like  the  capital  of 
the  Eoman  Empire,  it  is  easy  for  a  stranger,  and  even  for  a  citizen,  to 
conceal  his  name,  his  birth,  his  fortune,  and  his  conduct.  A  man  is 
only  judged  by  the  luxury  he  displays,  and  the  arrogance  he  exhibits. 
If  accidentally  he  is  discovered,  it  will  suffice  for  him  to  change  his 
location :  while  in  a  small  town,  all  the  inhabitants  know  each  other  ; 
a  man's  relatives,  education,  and  manner  of  life,  are  so  well  understood 
that  fraud  is  impossible." 

In  the  midst  of  this  overflowing  of  charlatanism,  the  health  of  the 
citizens  was  given  over  to  the  mercy  of  the  first  im2)0ster  who  called 
himself  a  doctor  ;  for  how  could  the  cheat  and  usurper  of  the  title  be 
■  distinguished  from  the  man  of  knowledge  and  probity,  who  had  acquired 
it  by  study  ?  No  examination,  no  legal  proof  was  imposed  on  any  one 
who  wished  to  practice  Medicine  ;  there  was  no  security  for  the  sick. 
Such  a  disorder  could  not  always  exist,  and  the  excess  of  the  evil  led 
to  its  suppression,  which  in  fact  was  brought  about.  Thus  finishes  the 
^third  phase  of  the  medical  profession,  which  we  shall  call  the  unlicensed 
■laity  phase. 

FOURTH   AND  LAST    PHASE. 

The  abuse  to  which  this  indefinite  liberty  led,  in  the  practice  of 
Medicine,  having  become  intolerable,  the  legislative  power  was  obliged 
to  interfere.  Now  commences  for  the  medical  profession  a  new  phase, 
which  I  shall  call  the  legal  or  organized  laity  jj/tase. 

The  Emperor  Anthony  the  Pious,  was  the  first  who  occupied  himself 
with  this  subject.  He  made  mention,  in  several  of  his  rescripts,  of  the 
immunities  to  which  those  physicians  had  a  right,  who  were  employed  in 
the  public  service,  whether  civil  or  military ;  but  there  is  no  evidence 
yet  of  examinations  or  proofs  of  qualifications,  and  we  can  only  suppose 
their  existence.--  It  is  necessary  to  go  as  far  back  as  the  Christian 
Emperors  to  discover  the  traces  of  a  regular  medical  organization.  It 
■was  then,  only,  that  the  title  of  Archiater  received  a  legal  sense,  and 
that  certain  functions  were  attached  to  it ;  while  it  docs  not  appear  to  have 

^  Justiniani  Codocis,  lib.  x.  tit.  m.  De  Professoribus  et  Medicis,  i.  Digestorum, 
lib.  xxvii,  tit.  I.    De  Excusationibus,  vi,  §1,  2. 


MEDICAL   ORGANIZATION.  251 

been,  ever  before,  more  than  an  honorary  title — an  ambitious  distinction, 
excited  by  vanity,  and  often  usurped.  Andromachus,  physician  to  Nero, 
was  decorated  with  it ;  but  Galen,  physician  to  Marcus  Aurelius,  never 
bore  it.  From  the  time  of  Constantine  the  Great,  the  name  of  Archiater 
is  frequently  met  with  in  the  edicts  of  the  Emperors.  It  served  to 
designate,  sometimes,  the  physicians  attached  to  the  person  of  the  sov- 
ereign, sometimes  physicians  fulfilling  certain  public  functions  in  cities. 

There  were,  consequently,  two  sorts  of  Archiaters ;  one  named  Palatine, 
who  belonged  to  the  household  of  the  prince,  holding  rank  amongst  the 
officers  of  the  court,  and  having  at  their  h^d  a  count  or  duke,  who  was 
a  peer  with  the  higher  dignitaries  of  the  Empire.  He  bore  the  title  of 
Count  Archiater,  or  Count  of  the  Archiaters,  for  historians  differ  in 
opinion  in  regard  to  these  two  denominations. '■■'  The  others,  called 
Popular  Archiaters,  formed  in  each  town  a  kind  of  college,  charged  with 
the  supervision  of  everything  that  related  to  salubrity.  No  one  could 
practice  medicine  in  their  jurisdiction  without  having  been  examined  by 
them,  and  recognized  as  sufficiently  instructed.  Whoever  transgressed 
this  regulation,  was  punished  with  a  fine  of  two  thousand  drachms. 
These  Archiaters  were  honorably  pensioned  by  the  State,  and  enjoyed 
various  privileges.  In  return  for  these  advantages,  they  were  obliged  to 
wait  upon  the  poor  gratuitously  ;  but  they  had  the  right  to  charge  those 
who  were  rich  or  in  easy  circumstances.  The  practitioners  who  were  not 
members  of  the  College  of  Archiaters,  had  no  immunity,  and  lived  upon 
the  product  of  their  practice. 

The  Popular  Archiaters  amounted  to  ten  in  the  metropolis ;  seven,  in 
cities  of  the  second  order,  and  five  in  those  below.  They  were  not  chosen 
by  the  Governor,  but  elected  by  the  citizens,  from  among  the  candidates 
who  had  given  proof  of  their  capacity  before  the  College,  and  obtained 
its  approbation.!  Such  was  the  first  medical  organization  destined  to 
remedy  the  frightful  evils  of  anarchy.  It  subsisted  until  the  dismem- 
berment of  the  Empire  by  the  barbarians. 

It  was  during  this  period,  about  the  year  400  of  our  era,  that  we  see 
designated  for  the  first  time  in  medical  books  a  class  of  citizens  to  whom 
was  confided  the  duty  of  preparing  the  drugs  ordered  by  physicians.} 
Their  functions  had  some  analogy  with  those  of  our  apothecaries,  though 
in  knowledge  and  social  position  no  comparison  can  be  made  between 
the  pharmaceutists  of  our  day  and  their  obscure  predecessors.  Before 
this  epoch  the  physicians  prepared,  themselves,  or  caused  their  students 

"Histoire  de  la  Chirurgie,  T.  II,  lib.  vi,  p.  715. 
■j-Degest,  T.  IX,  lib.  l.     De  decretis  ab  ordine  faciendis. 
I  Oribas.     In  prcemio  Euporistorum,  ad  Eunapium, 


252  GREEK   PERIOD. 

or  servants  to  prepare,  the  remedies  which  they  needed  in  their  practice, 
as- is  shown  from  various  passages  in  Hipprocrates  and  Galen.  The 
Pharmacopolists  who  were  mentioned  by  writers  anterior  to  the  fourth 
century,  were  only  druggists,  or  herbalists,  to  whom  the  physicians  went 
to  obtain  simple  substances,  necessary  for  the  confection  of  compound 
remedies.  Perhaps,  also,  some  of  these  pharmacopolists  kept  always 
ready  some  remedies  of  frequent  and  daily  use,  such  as  the  theriacS' 


CHAPTEE    III. 

INSTITUTIONS  ACCESSORY  TO  MEDICINE. 

I  comprehend  under  this  title  the  hospitals  and  hospices,  the  dispen- 
saries and  all  the  establishments  which  enable  the  necessitous  classes  to 
participate  in  the  relief  afforded  by  medicine.  Pagan  antiquity  has 
transmitted  us  no  model  of  institutions  of  this  order,  unless  one  of  the 
gymnasia  of  Athens,  called  Cynosarge,  be  called  such,  in  which  aban- 
doned children  were  nurtured  and  brought  up  at  the  public  expense,  until 
they  reached  an  age  to  be  able  to  serve  the  Piepublic ;  or  also  those 
retreats  which  were  established  by  several  cities  of  Greece  for  the  relief 
of  meritorious  citizens.  Eome  never  had,  either  under  the  Eepublic  or 
under  her  idolatrous  Emperors,  similar  establishments.  She  effected  the 
same  thing  by  frequent  distributions  of  provisions  or  lands,  by  the 
remission  of  unpaid  taxes  or  some  special  duties,  by  the  permission 
accorded  to  parents  to  destroy  newly-born  children  whom  they  were 
unable  to  maintain,  by  the  bond  of  patronage  which  united  patrician  to 
plebian  families,  and  made  it  a  duty  of  both  to  succor  each  other  in 
times  of  their  distress.  As  to  the  slaves,  they  were  cared  for  by  their 
masters  as  his  property,  like  his  cattle  or  his  flocks.  The  rights  of 
hospitality  established  between  families,  cities,  and  provinces,  and 
religiously  observed,  assured  to  travellers  subsistence  and  shelter ;  but 
none  of  these  institutions  resemble  our  modern  hospitals — nothing  of  all 
this  bears  the  character  of  an  establishment  destined  to  receive  the 
afflicted  poor. 

*Dujardin  et  Peyrilhe,  Histoire  de  la  Chirurgie,  liv.  v,  T.  w,  p.  61,  et  sui. 
According  to  this  author,  the  first  attempt  at  medical  organization  in  the  Roman 
Empire  goes  back  to  the  fourth  or  even  the  third  century  of  our  era  ;  while  Cu- 
vier  says  it  only  commenced  in  the  fourth  century,  on  the  model  of  the  scientific 
establishment  founded  in  Persia  by  the  Nestorians.  Hist,  des  Scienc.  Natur.,  by 
Cuvier,  edited  by  M.  Magdeleine  de  Saint-Agy,  Paris,  1841,  T.  i,  p.  409. 


INSTITUTIONS  ACCESSORY  TO   MEDICINE.  253 

It  is  to  Christian  charity  that  we  owe  the  foundation  of  the  first 
alms-houses  and  asylums.'"  Modern  researches  teach  us  that  at  the  end 
of  the  fourth  century,  Saint  Pauline,  a  Eoman  lady  of  illustrious  birth, 
after  exhibiting  the  spectacle  of  the  rarest  virtue  in  the  midst  of  worldly 
pomp,  resolved  to  retire  from  society,  in  order  to  continue,  more  uninter- 
ruptedly, a'life  entirely  devoted  to  charity  and  self-denial.  She  went  to 
Jerusalem,  first  cradle  of  the  faith,  and  theater  of  the  greatest  wonders, 
where  she  united  with  other  Christian  women  of  the  same  mind,  and 
formed  with  them,  under  the  direction  of  St.  Jerome,  a  pious  congrega- 
tion, who  divided  their  time  between  the  reading  of  sacred  books  and 
the  practice  of  good  works. 

The  faithful,  who  came  in  crowds  to  visit  these  venerated  places, 
actuated  by  pious  motives,  and  had  established  there  their  residences, 
were  often  exposed  to  severe  privations,  and  though  they  supported  them 
with  stoic  fortitude,  or  rather  with  the  resignation  of  martyrs,  their 
sufierings  could  not  fail  to  touch  the  hearts  of  their  brethren  in  Jesus 
Christ.  Their  lot  appeared  particularly  to  excite  pity,  in  regard  to  their 
diseases  or  infirmities.  To  oflFer  them,  in  these  severe  circumstances, 
an  asylum,  where  they  would  receive  the  attention  of  the  kindest  charity, 
united  to  the  counsels  of  art,  was  to  fulfil  for  them  the  ofiices  of  Provi- 
dence ;  it  was,  also,  in  the  opinion  of  those  who  discharged  them,  the 
best  means  in  the  eyes  of  God,  of  redeeming  all  the  imperfections  and 
weaknesses  of  human  nature.  Such  a  thought  was  well  calculated  to 
excite  instinctive  compassion  in  a  sex  eminently  sympathetic.  These 
holy  women  agreed  to  execute  the  project  of  founding  a  hospice  for  the 
benefit  of  the  indigent  sick  ;  and  for  the  purpose  of  putting  the  last 
seal  to  this  work  of  mercy,  they  bought  a  house  out  of  the  city,  to  which 
they  sent  the  convalescent,  to  breathe  a  pure  air,  and  rejoice  in  the 
charms  of  the  country,  so  salutary  for  persons  who  are  recovering  from 
disease. 

In  the  end,  the  Emperors,  Kings  and  Califs  signalized  their  zeal  in 
the  erection  of  sumptuous  edifices  for  the  relief  of  human  misery,  and  in 
bestowing  upon  them  rich  legacies.  Then  dispensaries  and  benevolent 
societies  were  instituted,  to  complete  the  work  of  public  charity.  In 
fine,  these  establishments,  which  had,  at  first,  only  a  philanthropic  end, 
turned  to  the  advantage  of  the  Art,  and  contributed  admirably  to  the 
progress  of  the  science. 

^^  Consult,  on  this  subject,  Percy  et  Willaume's  Memoir  on  this  question:  "Had 
the  ancients  public  establishments  for  the  benefit  of  the  indigent  orphan,  or  aban- 
doned children,  or  for  sick  and  wounded  soldiers  ?  If  they  had  not,  what  supplied 
their  place?"  Paris,  181.3,  in  8  vo. 


254  GREEK   PERIOD. 

RESUME    OF    TUB    GREEK    PERIOD. 

In  the  times  of  Galen,  animals  were  still  dissected,  and  this  professor 
tells  us  that  he  made  his  anatomical  demonstrations  on  monkeys,  whose 
conformation  so  closely  resembles  that  of  man.  Sometimes  the  physi- 
cians who  followed  the  armies  obtained  permission  to  open  the  corpse 
of  some  barbarian  taken  from  the  field  of  battle ;  but,  ultimately,  the 
practice  of  dissection  entirely  ceased,  and  the  conformation  of  the  human 
body  was  only  studied  in  books,  as  the  horror  of  the  early  Christians 
against  cadaveric  researches  was  more  decided  even  than  that  of 
Pagans ;  and  the  fathers  of  the  primitive  church  launched  their  anathe- 
mas against  the  violation  of  the  mortal  remains  of  man. 

This  abandonment  of  anatomy  contributed,  doubtless,  to  the  decadence 
of  the  healing  Art ;  but  other  causes  concurred  no  less  powerfully.  In 
the  first  rank  must  be  placed  the  rapid  extension  of  Christianity,  which 
disorganized  the  Pagan  schools,  discredited  the  profane  sciences,  and 
ruined  their  teachers.  It  engendered  in  every  mind  the  passion  for 
religious  controversy,  which  excited  so  much  trouble  in  the  rising 
Church,  and  hastened,  as  is  known,  the  fall  of  the  Empire  of  the 
East. 

In  the  second  place,  the  limited  number  of  those  who  continued  at- 
tached to  the  culture  of  the  Natural  Sciences,  enchained  by  a  vicious 
method,  only  sought  the  explanation  of  the  phenomena  of  Nature  in  the 
writings  of  the  ancients  ;  and  not  daring  to  advocate  any  change  in 
regard  to  the  received  doctrines,  dragged  heavily  in  the  rut  of  the  past. 
Two  men,  only,  Alexander,  of  Tralles,  and  Paul,  of  JEgina,  in  the  lapse 
of  more  than  four  centuries,  showed  the  least  originality  ;  the  one 
enriched  intei-nal  pathology  and  therapeutics  with  a  few  observations — 
the  other  added  moi-e  marked  improvements  to  surgery. 

But  if  the  period  we  have  passsed  over  was  unfruitful  in  scientific 
progress,  it  was  not  so  in  social  amelioration.  The  commencement  of 
organization  that  the  teaching  and  practice  of  medicine  received  was 
probably  more  profitable  to  humanity  than  might  have  been  discoveries 
in  the  science ;  for  we  have  seen  that  charlatanism  had  reached  its  acme. 
A  law  destined  to  keep  it  in  check,  by  requiring  certain  conditions  of 
capability  and  good  character  on  the  part  of  the  aspirant  to  the  medical 
profession,  responded  then,  under  the  circumstances,  to  an  urgent 
necessity,  and  such  a  law  is  at  all  times  a  benefit  to  society.  In  fine^ 
the  charitable  institutions  of  which  this  epoch  offered  to  the  world  the 
first  model,  prepared  for  the  future  valuable  means  of  medical  instruc- 
tion. The  first  period,  then,  of  the  age  of  transition,  was  not  entirely 
lost  to  the  future  of  science,  and  especially  to  that  of  humanity. 


GENERAL  CONSIDERATIONS.  255 


VI.   AEABIC  PERIOD. 


COMMENCING  AT  THE  DESTRUCTION  OF  THE  ALEXANDRIAN  LIBRARY.  IN  THE 
YEAR  640  OF  THE  CHRISTIAN  ERA,  AND  ENDING  AT  THE  CLOSE  OP  THE  FOUR- 
TEENTH CENTURY. 


GENERAL     CONSIDERATIONS. 

At  the  epocli  when  this  period  commences,  the  Empire  of  the  West  no 
longer  existed.  The  finest  provinces  which  composed  it  had  been  over- 
run and  subdued  by  barbarous  tribes  from  the  forests  of  Germany.  From 
its  ruins  had  already  arisen  several  independent  kingdoms,  of  which  the 
most  considerable  were  those  of  the  Francs  in  Gallia,  of  the  Visigoths 
in  Spain,  and  that  of  the  Lombards  in  Italy.  Justinian,  who  reigned  a: 
century  previously,  was  the  last  of  the  Eoman  Emperors  whose  arms 
threw  a  passing  glory  over  Italy,  Sicily,  Africa,  and  Spain,  thanks  to 
the  skill  of  some  of  his  generals,  and  especially  to  the  genius  and  heroic 
devotion  of  Belisarius. 

The  Empire  of  the  East,  attacked  at  all  points,  still  sustained  itself 
with  vigor,  though  losing  daily  some  one  of  its  supports,  similar  to  a 
fortress  reputed  to  be  impregnable,  which,  encircled  by  its  enemies,  sees 
fall  one  after  another,  the  works  destined  to  defend  their  approach.  The 
Turks  had  begun  to  show  themselves  on  the  banks  of  the  Danube.  The 
Persians,  those  eternal  enemies  of  the  Eoman  name,  made  incessant  war 
upon  it,  sometimes  openly,  again  covertly.  At  last,  a  more  redoubtable 
enemy,  and  who  at  this  time  made  greatest  havoo  of  the  Empire,  had  just 
sprung  up  in  the  deserts  of  Arabia.  There  a  man  arose,  who  was  at  the 
same  time  legislator,  prophet,  and  conqueror,  having  united  under  one 
domination  and  one  worship  the  tribes  heretofore  divided  and  rivals ; 
forming  of  them  a  powei'ful  and  enthusiastic  nation,  animated  by  a 
thirst  of  conquest  and  an  ardor  of  proselytism.  Finally,  century  had  not 
passed  since  the  first  preaching  of  Mahomet,  and  already  Arabia  entire, 
India,  Syria,  and  Egypt,  were  in  the  hands  of  his  followers.  In  G-IO  or 
641,  Amrou  achieved  the  con(|uest  of  this  latter  kingdom  by  seizing 
Alexandria,  its  capital.  The  library  of  that  city,  composed  of  500,000 
volumes,  was  delivered  to  the  flames,  by  the  order  of  Omar  the  Second, 
successor  of  Mahomet ,  and  these  books,  says  the  historian  Abulpharage,. 


256  ARABIC   PERIOD. 

served  to  heat,  for  six  months,  the  public  haths,  which  numbered  nearly 
four  thousand.  Such  were  the  first  fruits  of  the  establishment  of 
Islamism /•'•■' 

Happily  the  fervor  of  proselytism  abated  somewhat  among  the  Mussul- 
man princes,  and  policy  more  frequently  guided  their  conduct  than  relig- 
ious zeal.  The  Arab  Califs  showed  themselves,  in  general,  the  protectors 
of  the  Arts,  Sciences  and  Commerce.  Several  among  them  endeavored 
to  collect  the  debris  of  the  scientific  treasures  of  antiquity,  which  had 
escaped  the  ignorant  fanaticism  of  their  predecessors.  More  tolerant  in 
matters  of  religion  than  the  Christian  Princes  of  their  times,  they 
received,  without  distinction  of  country  or  religion,  all  the  men  of  merit 
who  took  refuge  in  their  States,  gave  them  employment,  and  recompensed 
them  for  their  services.  On  this  account,  the  philosophers  and  perse- 
cuted heretics  often  sought  an  asylum  among  the  Infidels,  and  carried 
to  them,  in  return,  the  light  of  Greek  civilization. 

Among  the  sovereigns  of  this  nation,  who  distinguished  themselves  by 
an  enlightened  love  of  letters,  I  will  cite,  in  first  rank,  Haroun-al-Ea- 
schid,  the  Charlemagne  of  the  East — cotemporary  and  emulator  of  the 
glory  of  the  Emperor  of  the  Francs — the  hero  of  so  many  Arabic  tales 
and  poems,  and  whose  dominion  extended  over  Asia,  Africa  and  Europe, 
from  the  borders  of  the  Indus  to  the  heart  of  the  Spanish  Peninsula. 
He  embellished,  considerably,  the  city  of  Bagdad,  his  capital,  and  estab- 
lished there  public  schools,  mosques  and  hospitals.  Almamon,  his  son 
and  successor,  made  still  greater  efibrts  than  he,  in  favor  of  the  Arts 
and  Sciences.  He  founded  the  academy  of  Bagdad,  which  was  one  of 
the  most  celebrated  of  the  middle  ages ;  and  spared  no  eflforts  to  attract 
there  the  most  illustrious  savans  of  all  countries.  He  enjoined  on  his 
embassadors  to  buy  all  the  writings  of  the  philosophers  and  physicians 
that  could  be  found,  and  as  fast  as  they  were  forwarded  to  him  he 
caused  them  to  be  translated  into  Arabic.  The  interpreter  Honain,  who 
was  a  Christian,  was  emploped  in  this  work  for  forty  years,  and  for  each 
book  he  translated,  he  was  paid,  literally,  its  weight  in  gold. 

The  eclat  that  the  dominion  of  the  Moorish  Kings  shed  upon  Spain, 
from  the  tenth  to  the  thirteenth  centuries,  is  well  known.  Several 
cities  possessed  schools,  public  libraries  and  academies.  Those  of  Cor- 
dova, Toledo,  Seville  and  Murcia  were  celebrated  in  all  the  West,  and 
students  went  to  them,  from  all  parts  of  Europe,  to  be  instructed  in  what 
were  termed  at  that  epoch,  the  Arts  and  Sciences  of  the  Saracens.     The 

"  Some  modern  critics  have  questioned  the  burning  of  the  Alexandrian 
Library  by  the  Arabs ;  but  M.  Matter  has  established  that  fact  on  incontestible 
proofs. 


MEDICINE   OF   THE   ARABS.  257 

library  of  Cordova,  the  capital  of  the  kingdom,  embraced  more  than 
224,000  volumes.  Thus  the  literary  and  scientific  scepter  passed  from 
the  hands  of  the  Greeks  and  Eomans  into  those  of  the  Arabs.  AVe  now 
proceed  to  see  what  became  of  Medicine,  among  them. 


CHAPTEK     I. 
MEDICINE   OF  THE   ARABS. 

§!• 

Ehazes,  or  Easis,  is  the  first  physician  of  any  eminence,  who  wrote 
in  the  Arabian  language.  He  was  of  Persian  origin,  and  flourished 
toward  the  end  of  the  ninth  century  and  the  beginning  of  the  tenth. 
If  we  may  believe  the  histoiians  of  his  nation,  who  are  naturally 
inclined  to  exaggeration  and  the  marvelous,  he  was  a  universal  genius, 
who  had  acquainted  himself  with  music,  astronomy,  mathematics, 
chemistry,  medicine,  etc.  It  is  certain  that  at  the  age  of  thirty  years 
he  was  one  of  the  most  distinguished  professors  of  the  academy  of  Bag- 
dad, and  that  students  came  from  a  great  distance  to  hear  his  lectures. 
Chosen  from  among  a  hundred  of  the  most  skillful  physicians,  to  direct 
the  grand  hospital  of  that  capital,  he  displayed  in  the  exercise  of  his 
functions  an  indefatigable  zeal,  even  to  his  old  age.  He  had  attained 
his  eightieth  year  when  the  loss  of  sight  compelled  him  to  quit  his  prac- 
tice. His  reputation  was  then  at  its  height.  It  is  easily  conceived  that 
a  man  of  his  acquirements,  nurtured  in  the  writings  of  the  ancients,  and 
placed  for  so  many  years  in  a  post  so  favorable  for  medical  observation, 
must  have  acquired  rare  skill  in  the  knowledge  and  treatment  of  dis- 
eases. He  was  surnamed  the  Experienced,  on  account  of  his  great 
experience. 

Ehazes  wrote  much  on  philosophy,  medicine,  history  and  chemistry; 
but  the  greater  part  of  his  works  are  lost,  or  are  buried  in  the  depth  of 
of  some  library.  We  have,  from  him,  two  treatises  on  medicine,  the 
briefest  of  which,  dedicated  to  the  Calif  Almanzor,  contains  excellent 
counsel  on  the  choice  of  a  good  physician.  Here  are  some  of  the  recom- 
mendations he  has  given  on  the  subject:  "Study,  carefully,  the  ante- 
cedents of  the  man  to  whose  care  you  propose  confiding  all  you  have 
most  dear  in  the  world ;  that  is  to  say,  your  health,  your  life,  and  the 
health  and  lives  of  your  wife  and  children.  If  the  man  is  dissipating 
his  time  in  frivolous  pleasures ;  if  he  cultivates  with  too  much  zeal  the 


258  ARABIC   PERIOD. 

arts  that  ai-e  foreign  to  his  profession,  such  as  music  and  poetry  ;  still 
more,  if  he  is  addicted  to  wine  and  debauchery,  refrain  from  committing 
into  such  hands  a  trust  so  precious.  He  merits  your  confidence,  who, 
having  early  applied  himself  to  the  study  of  medicine,  has  sought  skill- 
ful instructors  and  seen  much  disease;  who  has  united  to  the  assiduous 
reading  of  good  authors,  his  personal  observations  ;  for  it  is  impossible 
to  see  everything  and  try  everything  in  one's  own  practice ;  and  the 
knowledge  and  experience  of  a  single  individual,  compared  to  the 
knowledge  and  skill  of  all  men,  of  all  ages,  resembles  a  slender  brook 
of  water  that  flows  by  the  side  of  a  great  river." 

i  The  greatest  work  of  Ehazes,  entitled  "  Continens,"  is  a  collection  of 
extracts,  which  he  compiled  from  all  authors,  for  his  own  use.  It  is 
divided  into  two  parts,  which  comprise,  together,  thirty-seven  books, 
and  form  an  abridgment,  somewhat  confused,  of  Medicine  and  Surgery 
entire.  The  first  part  treats  of  diseases  which  attack  a  particular  organ, 
and  commences  with  the  head  and  finishes  with  the  inferior  members. 
The  second  part  treats  of  diseases  whose  seat  is  sometimes  in  one  part 
of  the  body  and  then  in  another,  as  phlegm,  erysipelas,  wounds,  etc., 
as  well  as  those  which  afi"ect,  or  seem  to  affect,  all  the  economy  at  once, 
such  as  fever,  the  plague,  etc. 

The  books  which  make  up  the  Continens,  though  arranged  after  a 
certain  order,  do  not  constitute  a  work  fixed  upon  any  uniform  plan, 
whose  parts  follow  each  other  regularly,  but  is  rather  like  a  collection 
of  notes,  extracts  and  souvenirs,  which  were  probably  not  designed  to  be 
published,  or,  at  least,  not  in  the  state  in  which  we  possess  them.  This 
collection,  rich  in  facts  and  erudite  quotations,  is  more  interesting  in  a 
historical  than  a  scientific  point  of  view ;  for  it  embraces  nothing,  or 
next  to  nothing,  which  is  not  found  in  Greek  authors,  unless  we  except 
the  indications  for  some  remedies,  introduced  by  the  Arabs  into  the 
materia  medica,  and  a  special  mention  of  eruptive  fevers,  comprised 
under  the  name  of  variola.  These  diseases  having  been  described  for  the 
first  time  by  the  Arabian  physicians,  it  has  necessarily  been  concluded 
that  they  originated  in  Arabia,  and  had  not  been  seen  by  the  Greek 
and  Latin  physicians  of  the  previous  age.  This  opinion  is  certainly 
easy  to  sustain,  but  before  admitting  it  in  an  absolute  manner,  let  us 
see  what  the  most  ancient  authentic  documents  that  we  possess,  say 
concerning  these  diseases.  Ehazes  expresses  himself  as  follows,  in  the 
thirtieth  book  of  the  Continens  : 

"Galen  says,  in  his  fourth  book,  on  Habits,  that  the  ancients  called 
a  phlegmon  a  disease  in  which  heat  caused  an  efi'ervescence,  as  in 
erysipelas  and  variola.  These  afi"ections  are  caused  by  the  bile.  He 
repeats  the  same  in  his  treatise  on  the  pulse,  and  in  the  ninth  book,  on 


MEDICINE   OF  THE  ARABS.  259 

Internal  Diseases,  in  these  terms :  '  Superfluous  matters,  -wliicli  are  not 
converted  into  blood,  become  putrefied,  and  at  length  attenuate,  giving 
rise  to  erysipelas  and  variola.' 

''  He  says  again,  in  his  fourth  book,  on  the  Pulse :  '  The  blood  becomes 
so  much  putrefied  in  apostema,  variola,  and  eruptions,  as  to  burn  the 
skin.'  I  affirm,  also,  that  Galen  has  designated  variola  by  its  name,  has 
laid  down  its  special  treatment,  and  it  may  be  inferred  from  his  expres- 
sions, that  he  considered  its  pustules  as  indicating  a  species  of  crisis." 

It  is  evident  from  the  above,  that  Ehazes  did  not  consider  variola  as 
a  new  disease,  nor  peculiar  to  his  country.  His  testimony  is  of  great 
weight  in  the  question  under  consideration  ;  but  it  would  have  more,  if 
the  passages  he  has  cited  from  Galen  existed  in  the  editions  that  we 
possess.  I  avow  that  I  have  not  been  able  to  find  them,  which  should 
not,  however,  invalidate  what  he  advances  ;  because,  the  copies  which 
the  Arabian  physician  possessed,  differed,  probably,  very  much  from 
ours.  Besides,  I  will  add,  with  Doctor  Bruno,  a  learned  Hellenist  of 
the  seventeenth  century  :  "  This  question  does  not  appear  to  me  to  have 
as  much  importance  as  it  formerly  was  supposed  to  possess,  and  it  is 
not  improbable,  that  the  ancients  may  have  designated  these  diseases  by 
the  names  of  pustules  and  exanthemata,  (^zxd'Jfj.o.Tcou,  vel  siavdr^iiazcov,) 
which  are  so  frequently  met  with  in  their  books."  ■■■' 

The  Continens,  notwithstanding  the  imperfect  state  in  which  it  exists, 
has  been  held  in  great  esteem  among  the  Orientals,  and  even  among  the 
Latins.  The  Arabian  writers,  posterior  to  Ehazes,  have  drawn  from 
this  collection  as  from  a  common  fund  of  knowledge.  For  the  most 
part,  they  have  only  disposed  in  a  better  order,  or  edited  with  more 
elegance  and  correctness,  the  abundant  material  which  they  found  in  it.f 

§11. 
Haly-Abas,  also  a  Persian,  flourished  toward  the  close  of  the  tenth 
century,  about  fifty  years  after  Ehazes.  He  wrote  under  the  title  of 
Almaleki  {opus  regium)  a  treatise  in  twenty  books,  which  forms  a 
complete  system  of  the  theory  and  practice  of  Medicine,  and  which  is 
extracted,  in  a  great  measure,  from  the  "  Continens."  It  is  generally 
argued,  in  regard  to  this  composition,  that  it  is  the  best  which  has 
proceeded  from  the  pens  of  the  Arabian  writers.  It  has  the  preference, 
even  now,  over  the  "Canon"  of  Avicenna,  of  which  we  shall  speak 
presently,  though  the  latter  had  much  greater  vogue  during  the  middle 
ages,  among  the  Occidentals. 

-  Lexicon  Medicum  Graeco-Latinum.     Vide  Morbilli. 

■]•  G.  Cuvier  thinks  that  the  Continens  was  not  written  by  Rhazes,  but  is  a 
collection  of  his  oral  lectures,  published  by  some  one  of  his  pupils. 


260  AEABIC   PERIOD. 

§111. 

Avicenna,  surnamed  the  Prince  of  Physicians,  was  born  at  Bokhara, 
a  considerable  city  of  Khorassan,  in  the  year  of  grace  980.  He  mani- 
fested, from  the  most  tender  age,  an  extraordinary  disposition  for  the 
sciences.  His  ardor  for  study  was  so  great  that  he  devoted  to  it  entire 
days,  and  the  greater  part  of  his  nights.  Having  gone  to  study  philo- 
sophy and  medicine  in  the  university  of  Bagdad,  his  talents  were  soon 
exhibited.  He  was  received  at  court,  loaded  with  favors,  and  elevated 
to  the  dignity  even  of  a  Vizier.  Then,  suddenly,  he  fell  into  disgrace, 
was  stripped  of  all  his  property,  cast  into  prison,  and  menaced  with  the 
loss  of  his  life.  After  two  years  detention,  he  recovered  his  liberty, 
acquired  anew  the  consideration  of  the  public  and  the  court,  and 
travelled  in  various  countries.  But  he  did  not  long  enjoy  this  return 
of  fortune.  Excessive  labors,  and  the  intemperance  to  which  he 
surrendered  himself,  gradually  undermined  his  robust  constitution  ;  he 
died  of  dysentery,  at  the  age  of  fifty-six. 

Avicenna  composed  several  works,  of  which  the  principal  is  called 
the  *'  Canon,"'-'  from  a  Greek  word  which  signifies  rule,  law.  The  Canon 
was,  indeed,  for  five  or  six  centuries,  a  classic  book,  and  may  be  said 
to  have  been  the  medical  code  of  Asia  and  Europe.  The  professors  of 
the  faculties  confined  their  teachings  for  a  long  time,  to  reading  it  from 
their  desks,  explaining,  translating,  and  making  extracts  or  compen- 
diums  from  it.  No  author,  after  Galen,  enjoyed  so  wide  and  durable 
an  authority  in  the  medical  world.  Although  now  dethroned  from  this 
high  position,  my  readers  will  not  object,  I  think,  to  acquire  some 
knowledge  of  an  author  so  renowned  in  former  times. 

His  entire  book  is  divided  into  five  volumes,  of  which  the  first  two 
embrace  the  general  principles  of  physiology,  pathology,  hygiene,  and 
therapeutics,  arranged  in  conformity  with  the  doctrines  of  Aristotle 
and  Galen,  and  may  be  termed  the  philosophic  part  of  the  science. 
The  third  and  fourth  books  contain  the  description  and  treatment  of 
all  the  diseases  then  known ;  the  last  treats  of  the  composition  and 
preparation  of  remedies.  The  entire  work,  from  one  end  to  the  other, 
as  all  other  works  of  this  period,  is  a  compilation,  neither  better  nor 
worse  than  the  Almaleki.  This  may  be  inferred  from  the  following 
fragments. 

DEFIXITION   OF    MEDICINE. 

"  I  say  that  ^Medicine  is  a  science  which  gives  the  knowledge  of  the 
conformation  of  the  human  body,  and  its  susceptibility  of  being  amended 

*  Canon  Medicinge. 


MEDICDTE   OF  THE   AEABS.  261 

or  modified  for  the  preservation  or  restoration  of  health."  This 
definition  is  somewhat  obscure  and  refined,  but  it  is  nothing  in  com- 
parison to  the  commentary  which  the  author  makes  upon  it. 

"  Some  one  may  say,"  he  continues,  "  that  Medicine  being  divided 
into  theory  and  practice,  I  am  wrong  in  calling  it  a  science,  which  indi- 
cates that  it  is  in  the  same  rank  of  purely  speculative  knowledge.  I 
reply  that  if  there  are  arts  exclusively  theoretical  and  others  exclusively 
practical,  Medicine,  the  same  as  philosophy,  is  at  once  theoretical  and 
practical. 

"  When  we  admit  into  a  science  two  branches,  the  one  theoretical  and 
the  other  practical,  we  attach  to  the  words  theory  and  practice  a  difi'er- 
ent  signification  from  the  vulgar  acceptation  of  the  terms,  which  it  is 
proper  to  explain.  We  are  not  willing  to  say,  for  example,  that  one 
branch  of  Medicine  is  devoted  to  demonstration  and  the  other  to  opera- 
tion ;  but  we  wish  to  have  it  understood  that  there  are  two  parts  in 
Medical  Science — one  which  treats  of  principles  without  having  in  view 
their  application,  and  the  other  which  sets  forth  the  rules  according  to 
which  we  should  operate.  Thus,  when  it  is  said  that  there  are  three 
sorts  of  fevers,  and  nine  temperaments  or  complexions,  the  science  is  ren- 
dered speculative  ;  on  the  contrary,  when  it  is  said  that  we  must  employ 
repercussives,  refrigerants  and  incrassants  in  the  onset  of  an  inflamed 
tumor,  then  repercussives  concurrently  with  the  emollients,  and  finally, 
toward  the  close  of  the  disease,  emollients  united  with  resolvents,  then 
we  treat  of  the  practical  part  of  the  science.  "••■^ 

I  avow,  that  after  having  read  and  re-read,  with  the  most  scrupulous 
attention,  this  passage  in  the  Latin  translation,  it  has  appeared  to  me 
difficult,  if  not  impossible,  to  attach  to  it  any  clear  and  precise  sense. 
Avicenna  here  seems  to  play  upon  words ;  he  surpasses,  in  subtilty, 
Aristotle  and  Galen,  whom  he  takes  for  models,  even  exaggerating  their 
defects.  Besides,  the  philosophic  teachings  of  the  schools  consisted  at 
that  time  only  in  the  subtilties  of  language.  The  book,  or  the  author 
whom  they  took  for  a  guide,  was  tortured  in  a  thousand  ways ;  they 
exhausted  themselves  in  seeking  the  thoughts  of  others,  in  place  ot 
thinking  for  themselves ;  the  struggle  consisted  in  who  should  refine 
most  a  word  or  a  phrase.  In  this  disposition  of  their  minds,  they  were 
frequently  disposed  to  regard  as  sublime  and  transcendent  what  was 
obscure  and  even  unintelligible ;  so  that  the  philosophic  part  of  the 
Canon  of  Avicenna,  that  which  treats  of  the  generalities  of  science,  and 
which  now  appears  the  most  defective,  seems  to  have  been  most  admired 
then,  and  has  contributed  most  to  the  prodigious  success  of  the  work. 

^  Canonis,  lib.  i,  fen  i,  doctrina  1 ;  Venetiis  apud  Juntas,  lo62. 


I 


262  ARABIC   PERIOD. 

In  the  second  part,  which  is  devoted  to  the  exposition  of  practical 
knowledge,  the  author  strays  farther  still  into  the  labyrinth  of  theory, 
which  renders  the  reading  of  his  work  difficult  and  fatiguing ;  but  there 
are  some  chapters  relative  to  eruptive  fevers,  that  all  judges  agree  in 
regarding  as  the  best,  and  which  throw  some  light  on  the  history  of  these 
diseases,  in  showing  the  views  held  in  regard  to  them  at  the  time  of 
their  first  appearance.     I  will  now  give  a  few  extracts  about  them. 

ON   VARIOLA. 

"  The  blood  manifests,  occasionally,  an  ebullition  similar  to  that  which 
is  seen  in  vegetable  juices,  producing  the  disaggregation  of  their  par- 
ticles. The  natural  cause  of  this  ebullition  is  nothing  else  than  the 
residue  of  the  menstrual  blood,  which  remains  in  the  womb  at  the 
moment  of  impregnation,  or  a  residuum  subsequently  engendered  from 
food  of  a  bad  quality,  and  deposited  there — that  kind  of  food  which 
rarefies  the  blood,  causing  its  ebullition,  until  its  sound  parts  predomi- 
nate, as  occurs  naturally  in  the  juice  of  the  grape,  in  a  state  of  ferment- 
ation, by  which  it  is  converted  into  a  liquor  of  uniform  composition. 
after  having  expelled  the  thick  froth  and  earthy  dregs."* 

This  analogy  must  appear  very  gross  and  ridiculous  to  many  young 
physicians  of  the  present  time,  so  much  is  it  unlike  the  doctrine  now 
accredited  in  the  schools;  but,  after  an  unprejudiced  examination,  it 
will  be  found  to  give  a  very  good  account  of  the  principal  phenomena 
which  characterise  eruptive  fevers,  and  particularly  variola.  These 
aifections,  as  is  well  known,  attack  so  universally  the  human  race,  as  to 
lead  to  the  belief  that  they  were  inherent  to  our  nature ;  and  that  each 
individual  contracted  the  germ  of  it  in  the  womb  of  his  mother.  In  the 
second  place,  would  not  the  regularity  and  violence  of  the  febrile  symp- 
toms, and  the  enormous  quantity  of  excrementitial  matter  ejected  from 
the  economy  by  the  eruption,  taken  all  together,  seem  to  prove  a  depu- 
rative  effort — a  synurgy  of  the  vital  forces,  for  the  purpose  of  eliminat- 
ing a  mischievous  humor  or  element  ? 

This  hypothesis,  clear,  simple,  and  natural,  has  been  admitted  almost 
without  contradiction  even  down  to  our  day ;  and  so  profoundly  was  the 
public  mind  imbued  with  it,  that  doctors  in  theology  proscribed  innocu- 
lation  and  vaccination  as  a  derogation  of  the  order  of  things  established 
by  Providence ;  and  doctors  in  medicine  repulsed  the  same  means,  as 
tending  to  retain  in  the  economy  a  venom  whose  expulsion  it  was  impor- 
tant to  favor.  But,  even  if  the  above  views  had  been  much  more 
rational  than  was  supposed,  they  did  not  authorize  the  consequences 

*Canonis,  lib.  vr,  fen.  i,  tractatus  iv,  chap.  vi. 


MEDICINE   OF  THE   ARABS.  263 

deduced  from  them.  Indeed,  even  if  it  were  true  that  we  contain,  on 
coming  into  the  world,  the  germ  of  certain  diseases,  or  a  proximate  dis- 
position to  contract  them,  it  need  not  follow  that  the  germ  or  the  ten- 
dency must  be  left  to  develops  themselves  to  the  point  of  giving  origin 
to  such  formidable  phenomena,  if  we  have  a  milder  and  surer  means  of 
destroying  such  a  bad  predisposition. 

SIGNS    OF    THE   APPEARANCE   OP   VARIOLA; 

"  The  precursory  symptoms  of  variola  are,  ordinarily,  pain  in  the 
back,  itching  of  the  nose,  fright  during  sleep,  a  pricking  sensation 
all  over  the  face,  and  general  lassitude.  The  face  and  the  eyes 
become  red,  the  latter  being  constantly  suffused  with  tears  ;  and  nu- 
merous inflamed  spots  appear  on  the  skin.  The  patient  yawns  fre- 
quently, and  respiration  is  difl&cult;  the  voice  is  hoarse,  and  a  thick 
saliva  is  expectorated.  The  head  feels  heavy  and  aches,  while  the 
mouth  is  very  dry.  The  patient  realizes,  in  the  throat  and  chest,  a 
painful  constriction  ;  the  feet  tremble  and  fall  backward.  All  this 
morbid  train  is  accompanied  by  fever." 

This  graphic  tableau  does  not  approach  the  perfection  of  those  that 
Aretseus  and  Alexander  of  Tralles  have  left  us.  No  distinction  is  made 
here,  either  in  regard  to  the  gravity  or  the  frequency  of  the  symptoms, 
or  of  the  manner  in  which  they  succeed  each  other.  The  author  does 
not  tell  us  whether  it  is  necessary  for  all  of  them  to  appear  united,  or 
if  the  apparition  of  a  few  of  them  only  is  necessary,  to  prognosticate 
the  imminence  of  variola.  He  indicates,  no  better,  the  march,  charac- 
ters, and  duration  of  the  eruption  ;  nor  the  phases,  so  remarkable,  of 
the  fever,  which  attracted  particularly  the  attention  of  the  ancients. 

ON   THE   MORBILLI. 

The  writers  of  the  middle  ages  comprised  under  this  term  all  the 
febrile  exanthemata,  such  as  rubeola,  scarlatina,  and  roseola.  "  The 
morbilli,"  says  Avicenna,  "are  a  species  of  bilious  variola.  There  is 
scarcely  any  difference  between  these  two  classes  of  affections,  unless 
that  morbilli,  jDroceeding  from  the  bile  and  a  smaller  quantity  of  mor- 
bid matter,  do  not,  so  to  say,  affect  more  than  the  surface  of  the  skin, 
nor  produce,  in  general,  any  elevations  which  require  particular  treat- 
ment ;  while  variola  produces,  from  its  beginning,  elevations  and  pus- 
tules. The  morbilli  are  less  grave  and  less  apparent  than  variola; 
but  the  signs  of  their  invasion  are  pretty  much  the  same.  However, 
the  irritation  of  the  stomach,  difBcult  respiration,  and  general  inflam- 
mation have  more  intensity  in  morbilli,  while  the  pain  in  the  bones  is 
less  severe.     This  pain,  in  variola,  is  caused  by  the  abundance  of  the 


264  ARABIC   PERIOD. 

blood,  whicli  distends  the  vein  that  runs  the  whole  length  of  the  spinal 
column,  for  variola  depends  upon  the  quantity  of  corrupt  blood,  while 
the  morbilli  depend  on  the  quality  of  it.  The  variola  irruption  is 
gradually  developed,  while  that  of  morbilli  occurs,  ordinarily,  in  a 
sudden  manner." 

We  see,  by  the  above,  that  the  physicians  of  those  times  divided 
eruptive  fevers  into  two  classes  only.  The  first  class  comprehended' 
under  the  denomination  of  variola,  all  the  eruptions  which  consist  in 
pimples,  more  or  less  prominent,  filling  up  with  any  liquid — such  as 
pustules,  bullae,  and  vesicles.  The  second  embraces,  under  the  title  of 
morbilli,  eruptions  in  which  the  skin  is  covered  with  spots,  large  patches. 
or  pimples,  barely  salient,  and  containing  no  liquid.  That  was,  un- 
questionably, a  very  philosophic  division,  and  it  still  remains  in  our 
science.  The  second  species  received  the  name  of  morbilli,  which  sig- 
nifies a  little  disease  or  little  pest,  because  the  affections  which  they 
represent  were  regarded  as  less  grave,  and  as  engendered  by  a  smaller 
quantity  of  morbific  matter,  than  the  affections  of  the  first  order. 
Finally,  it  is  to  be  remarked,  that  all  the  authors  of  that  period 
range  eruptive  fevers  in  the  class  of  pests,  or  epidemic  pestilential 
fevers. 

In  going  back  to  antiquity,  the  history  of  diseases  seems  to  me  to 
offer  three  distinct  phases :  in  the  first,  no  allusion  is  made  to  erup- 
tions ;  they  were  considered  as  epi-phenomena  of  little  importance — a 
sort  of  crisis,  according  to  Ehazes ;  whereas  the  febrile  symptoms,  which 
indicate  the  state  of  the  vital  forces  and  the  intensity  of  the  danger, 
attracted  all  the  attention  of  observers.  The  Asclepiadse,  who  even 
made  no  account  of  tetters,  lepra,  or  other  infirmities  3f  that  kind, 
might  well  neglect  transient  eruptions,  which  generally  leave  no  trace, 
or  of  which  the  cicatrices  constitute,  at  most,  a  mere  disfiguration.  In 
the  second  phase,  whether  eruptive  fevei's  had  suddenly  taken  an 
extraordinary  development,  or  that  they  passed  for  the  first  time  the 
limits  of  Arabia,  the  attention  of  physicians  was  more  directed  to  the 
characters  of  the  eruption,  and  they  distinguished,  consequently,  two 
species  of  it.  Finally,  the  third  phase,  which  extends  down  to  us,  in 
which  each  genus  is  divided  into  several  species,  founded  upon  the 

nature  of  the  eruption. 

§IV. 

Albucasis,  or  Alsaharavius,  a  native  of  Cordova,  lived  in  the  beginning 

of  the  twelfth  century.     He  wrote  an  abridgment  of  the  theory  and 

practice  of  Medicine,  a  mere  compilation,  in  which  is  found,  absolutely, 

nothing  new,  unless  it  be  a  little  treatis3  on  surgery,  which  terminates 

the  work,  as  a  kind  of  supplement,  and  which  does  him  more  credit  than 


MEDICINE   OF  THE   ARABS.  265 

all  the  rest  of  the  work.  This  last  fragment,  one  of  the  most  curious 
monuments  of  Arabian  Medicine,  includes,  among  other  interesting 
matter,  a  description  of  the  instruments  then  employed  in  surgical 
operations,  with  explanatory  figures.  The  reasons  which  decided 
Albucasis  to  write  this  treatise  on  operative  Medicine,  are  worthy  of 
being  known.     He  gives  them  himself,  in  the  following  language : 

"  After  having  terminated,  happily  enough,  the  work  on  Medicine 
which  I  undertook  for  your  instruction,  my  sons,  I  have  thought  it 
proper  to  add  to  it  a  small  treatise  ou  manual  operations,  seeing  that 
this  part  of  our  science  is  so  much  neglected  in  our  country  at  the 
present  time,  that  there  remain  scarcely  any  vestiges  of  it.  We  can 
only  find  a  few  short  descriptions  of  operations  in  the  books  of  the 
ancients  ;  they  are,  however,  disfigured  by  the  ignorance  of  the  book- 
makers ;  the  manuscripts  are  so  faulty,  that  at  every  step  we  are  in 
such  doubt  as  to  the  sense  of  the  authors,  that  no  one  dare  enter  into 
the  study  of  surgery.  I  have,  therefore,  undertaken  this  little  treatise 
for  the  purpose  of  reviving  this  most  important  and  useful  branch  of 
our  Art.  I  have  detailed  briefl5^  the  methods  of  operation,  I  have 
described  all  the  necessary  instruments,  and  I  present  their  forms,  by 
means  of  drawings  ;  in  a  word,  I  have  omitted  nothing  of  what  can 
shed  light  on  the  practice.  But  one  of  the  principal  reasons  why  it 
is  so  rare  to  meet  a  skillful  surgeon  is,  that  the  apprenticeship  to  this 
branch  is  very  long,  and  he  that  devotes  himself  to  it  must  be  versed 
in  the  science  of  anatomy,  of  which  Galen  has  transmitted  us  the 
knowledge.  He  should  know  the  functions  of  organs,  their  shape,  and 
their  relations ;  the  number  of  the  bones,  and  their  modes  of  union ; 
the  origin  and  termination  of  the  muscles,  the  nerves,  the  arteries,  and 
the  veins.  In  fine,  no  one  should  permit  himself  to  attempt  this  diffi- 
cult art  without  having  a  perfect  knowledge  of  anatomy,  and  the  action 
of  remedies."  •■' 

Observe,  that  Albucasis,  who  felt  so  much  the  necessity  of  acquiring 
extended  and  precise  notions  touching  the  structure  of  the  human  body, 
contents  himself,  by  referring  those  who  desire  to  instruct  themselves  in 
this  branch,  to  the  descriptions  of  the  physician  of  Pergamos.  He 
says  not  one  word  about  dissections,  which  leads  us  to  conclude  that 
they  were  not  tolerated  in  his  time,  and  that  he  never  practiced  them 
himself — at  least  in  an  ostensible  manner. 

He  divides  his  treatise  on  surgery  into  three  books.  In  the  first,  he 
shows  the  diseases  that  require  the  cautery,  the  various  methods  of 


*  Albucasis,  lib.  i.     The  best  edition  of  this  work  has  for  a  title,  Albucasis, 
De  Chirurgia  :  Arabice  et  Latine,  cur.  .J.  Channiag.     Oxonii,  1778,  2  vol.  quarto. 

17 


266  ARABIC   PERIOD. 

applying  it  by  fire  and  escarotics,  the  instruments  whicli  were  used,  and  the 
cautions  that  must  be  taken.  Enthusiastic  partisan  of  this  medication. 
he  counsels  it  in  a  multitude  of  cases  :  among  others,  in  spontaneous 
luxations,  and  in  the  commencement  of  curvatures  of  the  spine.  The 
second  book  is  devoted  to  the  operations  which  are  performed  by 
cutting  instruments.  The  author  describes  a  great  number  of  these, 
and  even  some  of  the  most  formidable.  But  among  the  chapters  which 
have  appeared  to  me  the  most  interesting,  I  will  cite  in  particular  those 
relative  to  forcible  delivery  and  the  extraction  of  the  afterbirth,  the 
mode  of  administering  clysters,  and  blood  letting.  A  fact  worthy  of 
remark,  and  which  the  reading  of  the  book  confirms,  is,  that  whenever 
it  became  necessaiy  to  explore  the  genitals  of  the  female,  the  physician 
must  never  proceed  himself  in  that  research,  but  always  employ  the 
ministry  of  a  sage-femme — an  uncertain  course,  which  the  excessive 
modesty  of  one  sex,  and  the  unbridled  jealousy  of  the  other,  imposed 
on  the  man  of  art.  The  third  book  treats  of  the  methodic  cure  of 
luxations  and  fractures.  The  author  remarks  that  this  part  of  surgery 
was  abandoned  to  men  of  vulgar  ancl  uncultivated  minds,  and  for  that 
reason  had  fallen  into  the  deepest  contempt. 

Though  he  assures  us  that  he  had  seen  with  his  own  eyes  all  that  he 
reports,  it  is  difficult  to  believe  what  he  recounts  of  multiplied  concep- 
tions, in  his  chapter  on  abortion.  He  speaks  of  several  women  who 
threw  ofi"  more  than  ten  embryos  in  a  single  fausse  couche,  and  of  one 
among  the  rest,  who  cast  oif  seventeen  !  It  seems  probable  that  our 
surgeon,  being  obliged,  under  the  circumstances,  to  believe  the  account 
of  the  matrons,  shows  himself  a  little  too  credulous  in  regard  to  their 
statements.  I  will  terminate  what  I  have  to  say  relating  to  this  author, 
by  the  following  statement  of  Fabricius  of  Aquapendente :  "  Celsus," 
hie  says,  "  among  the  Latins,  Paul  ^Egineta,  among  the  Greeks,  and 
Albucasis,  among  the  Arabs,  form  a  triumvirate  to  which  I  confess  I  am 
under  great  obligations." 


§  v.  reteospectrve  considerations  of  the  scientific  progress  of 
Medicine  among  the  Arabs. 

During  this  period  the  Arabs  embraced  with  much  ardor  the  study 
of  Medicine :  they  endeavored  to  translate  into  their  language  all  the 
treasures  that  Greece  had  amassed  on  this  science,  and  we  owe  to 
them  the  conservation  of  some  fragments  of  Greek  authors,  which  have 
not  in  any  other  way  come  down  to  us  ;  nevertheless,  we  possess  a  much 
greater  number  of  them,  of  which  the  former  were  entirely  ignorant  ; 
such,  for  example,  as  the  writings  of  Aretoeus  and  several  books  of 


MEDICINE    OF   THE   GKEEKS.  267 

Galen.  On  the  other  hand,  the  Arabs  neglected  entii'ely  the  Latin 
authors — they  did  not  know  Celsus,  nor  Coelius  Aurelianus — so  that 
thej  had,  on  the  antiquity  of  Medicine,  less  complete  notions  than  we, 
though  placed  much  nearer  the  sources  of  antique  knowledge. 

Anatomy  and  physiology,  far  from  making  any  conquests  under 
Arabian  rule,  followed,  on  the  contrary,  a  retrograde  movement.  As 
those  physicians  never  devoted  themselves  to  dissections,  they  were 
under  the  necessity  of  conforming  entirely  to  the  accounts  of  Galen ; 
consequently,  they  translated  his  descriptions  in  the  most  faithful 
manner  possible.  Xow,  in  a  work  of  this  kind,  the  inexactitudes  of 
the  translation  are  always  added  to  those  of  the  original,  if  the 
translator  does  not  correct  and  prevent  them  by  his  own  direct  obser- 
vations on  the  subject.  It  is  thus  easily  seen,  how  much  the  anatomy 
of  the  Arabs  must  have  been  inferior  to  that  of  the  Greeks,  which 
served  them  as  a  model. 

Pathology  was  enriched  in  the  Arabian  writings  by  some  new  obser- 
vations, the  most  important  of  which  we  have  pointed  out.  The 
physicians  of  this  nation  were  the  first,  as  we  have  already  said,  who 
began  to  distinguish  eruptive  fevers  by  the  exterior  characters  of  the 
eruption,  while  the  Greeks  paid  but  little  attention  to  these  signs. 

Therapeutics  made  also  some  interesting  acquisitions  under  the  Arab 
physicians.  It  owes  to  them,  among  other  thinjrs,  the  introduction  of 
mild  purgatives,  such  as  cassia,  senna,  and  manna,  which  replaced 
advantageously,  in  many  cases,  the  drastics  employed  by  the  ancients  ; 
it  is  indebted  to  them,  also,  for  several  chemical  and  pharmaceutical 
improvements,  as  the  confection  of  syrups,  tinctures,  and  distilled 
waters,  which  are  very  frequently  and  usefully  employed.  Finally, 
external  therapeutics,  or  surgery,  received  some  minor  additions,  such  as 
pomades,  plasters,  and  new  ointments  ;  but  t^ese  additions  were  verj- 
far  from  compensating  for  the  considerable  losses  which  it  suffered  by 
their  abandoning  a  multitude  of  operations  in  use  among  the  Greeks. 


CHAP  TEE    II. 

MEDICINE   OF   THE   GREEKS   DURING    THE   ARABIC   PERIOD. 

While  the  Arabian  nation  was  elevated  to  the  summit  of  the  social 
scale,  by  power,  intelligence,  and  renown,  the  Greek  nation  declined 
from  day  to  day.  Its  genius,  its  courage,  all  its  antique  virtues,  became 
gradually  weaker,  and  seemed  on  the, point  of  extinction.     The  historian 


268  ARABIC    PERIOD. 

of  Medicine  can  find  only  one  single  name  to  cite,  during  a  period  of 
nearly  seven  hundred  years,  and  he  is  not  an  original  author,  and  is 
out  of  the  regular  line ;  but  he  is  an  elegant  writer,  and  skillful 
compiler. 

Actuarius,  whose  true  name  is  John,  son  of  Zacharia,  lived  at  the 
close  of  the  thirteenth,  or  beginning  of  the  fourteenth  century.  He 
was  employed  at  the  court  of  Constantinople,  as  his  surname,  Actuarius, 
by  which  he  is  designated,  proves,  it  being  only  the  honorary  title  of 
the  physicians  of  the  palace.  We  have  no  details  of  his  life,  but  we 
know  that  he  has  written  much,  and  that  several  of  his  works  have 
not  come  down  to  us.  The  most  considerable  of  these,  extant,  is  an 
abridgment  of  Medicine,  in  six  volumes,  entitled,  "On  the  Cure  of 
Diseases,"  ='  in  which  is  found,  absolutely,  the  doctrines  of  G-alen, 
presented  in  a  compact  manner,  and  in  perfect  order.  The  theory  of 
critical  days  is  explained  there  in  the  most  lucid  manner,  and  sustained 
by  astronomical  hypotheses,  very  ingeniously  combined.  It  is  the  first 
Greek  work  in  which  mention  is  made  of  the  new  remedies  introduced 
by  the  Arabs,  such  as  mild  purgatives,  syrups,  juleps,  and  distilled 
liquors.  The  author,  however,  says  not  one  word  of  variola,  the 
morbilli,  spina  ventosa,  and  other  affections  described  by  the  physicians 
of  that  nation. 

His  treatise  on  animal  spirits,  divided  into  two  books,  is  remarkable 
for  the  connection  of  its  ideas ;  it  oiFers  the  quintescence  of  the  theory 
of  Galen  on  that  subject.  After  having  established  the  principle  that 
man  is  formed  by  the  union  of  two  contrary  substances,  the  soul  and 
the  body,  he  demonstrates  that  the  human  soul  dififers  from  the  soul  of 
brutes ;  that  it  is  an  emanation  of  the  Divinity,  a  simple  substance 
endowed  with  various  immortal  and  intelligent  faculties,  insensible  in 
its  nature,  though  capable  of  realizing  pain  and  pleasure,  by  the  inter- 
mediation of  spirits,  which  connect  it  closely  to  the  body. 

These  spirits  being  supposed  to  be  the  bond  that  places  the  soul  in 
communication  with  the  body,  it  became  very  important  to  acquire  exact 
notions  on  their  nature,  origin,  and  the  changes  to  which  they  are  sub- 
ject, and  the  means  to  prevent  or  combat  their  degeneration.  Our  physi- 
ologist explains  their  formation  as  follows  :  the  purest  juice  of  the  food 
digested  by  the  stomach  is  transported  to  the  liver,  where  it  serves  for 
the  composition  of  natural  spirits,  which  are  the  instruments  of  the 
concupiscible  faculty  of  the  soul.  These  are  carried  by  the  blood  into 
the  lambdoidal  vein,  one  branch  of  which  descends  toward  the  inferior 
regions,  and  the  other  mounts  upward  to  the  right  ventricle  of  the  heart. 

'^  De  Methodo  Medendi,  lib  vi. 


MEDICINE   OF  THE   LATINS.  269 

There  the  spirits  and  the  Wood  pass  into  the  left  ventricle,  to  be  elabo- 
rated and  changed  into  vital  spirits,  which  the  arteries  distribute  to  all 
parts  of  the  body.  Xow,  there  exists  at  the  base  of  the  brain,  an 
extremely  minute  plexus  of  arterial  and  venous  vessels,  which  is  called 
the  plexus  reticidaire.  It  is  there  that  the  vital  spirits  contained  in 
the  blood,  undergo  a  third  alteration,  which  transforms  them  into  animal 
spirits.  These  last  are  in  immediate  I'clation  to  the  soul ;  by  their  aid, 
that  immaterial  substance  perceives  the  sensations  of  exterior  objects, 
and  executes  the  most  elevated  functions."  '••' 

I  shall  not  show  the  anatomical  and  physiological  errors  of  this  theory. 
I  will  simply  observe,  that  the  admirable  plexus  in  which  were  elaborated 
the  animal  spirits,  does  not  exist  in  man.  But  if  we  admit  the  hypoth- 
esis of  Actuarius,  which  is  that  of  Galen,  and  nearly  all  the  physiolo- 
gists of  antiquity,  we  are  forced  to  admit  that  no  one  has  explained 
more  methodically  than  he,  the  functions  of  the  animal  economy,  and 
the  generation  of  diseases.  He  says  that  health  may  become  affected 
in  two  ways :  first,  when  the  humors  of  the  body,  being  too  abundant 
or  vitiated  in  their  composition,  permit  the  exhalation  of  confused 
vapors,  which  trouble  the  lucidity  of  the  spirits,  obscure  the  sensations 
of  the  soul,  and  cause  disorder  in  its  operations ;  secondly,  when  one  of 
the  elementary  qualities,  heat,  cold,  di-yness,  or  moisture,  is  in  excess  in 
any  part,  and  causes  derangement.  It  is  in  this  manner  that  our  physi- 
ologist appi'eciates  successively  the  influence  of  various  kinds  of  food,  sleep, 
watchings,  exercise,  repose,  the  passions,  remedies,  and,  in  one  word,  of  all 
hygienic  and  therapeutic  agents.  The  precepts  which  he  gives,  have  for 
their  end  to  conserve  the  clearness  of  the  spirits,  to  favor  the  coction  of 
the  humors,  and  prevent  their  alteration  or  superabundance,  and  to  re-es- 
tablish the  equilibrium  of  elementary  qualities.  In  short,  we  see  that 
his  system  is  perfectly  co-ordinated  according  to  logical  rules,  but  that 
it  is  based  on  gratuitous  hypotheses  and  material  errors. 


CHAPTER    III. 

MEDICINE  OF  THE  LATIXS  DURING  THE  SAME  PERIOD. 
GENE HAL     CONSIDERATIONS. 

At  the  commencement  of  this  period,  the  provinces  of  the  Empire  of 
the  West  present  a  most  painful  spectacle.  Swarms  of  barbarians  from 
the  forests  of  Germania  and  Scandina\4a  sweep  successively  over  it, 
pillaging,  and  killing  many  of  the  inhabitants,  and  reducing  the  rest  to 

"De  Spiritu  Animali,  lib.  i,  chap.  vi. 


270  ARABIC   PERIOD. 

a  state  of  slavery.  Everything  in  southern  Europe  is  changed  ;  laws, 
manners,  customs,  language,  institutions,  monuments!  Each  genera- 
tion sees  break  forth  some  new  and  unknown  horde  of  invaders,  which 
comes  to  demand  its  share  of  the  booty  and  renown,  leaving  a  more  or  less 
deep  trace  of  its  passage  over  the  countries,  lately  so  flourishing,  but 
now  ruined.  Eor  a  moment  the  genius  of  Charlemagne,  reuniting  under 
the  same  dominion  these  diverse  races,  seemed  to  resuscitate  the  Empire 
of  the  West,  but  scarcely  had  he  breathed  his  last  sigh,  when  the  ele- 
ments of  this  incongruous  empire,  having  no  affinity  among  each  other, 
became  separated.  The  great  vassals  of  the  crown,  no  longer  being  held 
by  so  vigorous  an  arm,  united  at  first  against  it,  then  against  each  other ; 
so  that  for  several  ages  there  was  nothing  but  an  uninterrupted  succes- 
sion of  wars  and  invasions,  without  definite  results.  A  species  of  organ- 
ization gave  some  sort  of  legitimacy  to  this  military  anarchy,  under  the 
name  of  feudalism.  There  was,  at  that  time,  neither  repose  nor  secu- 
rity for  any  one ;  the  weak  were  trampled  under  foot,  the  great  were 
constantly  under  arms  for  defense  or  attack.  With  difficulty,  a  few 
men  found,  in  the  pale  of  the  Church,  a  little  calmness  and  leisure  to 
devote  themselves  to  the  study  of  theology  and  ecclosiastical  law.  Pro- 
fane letters,  as  well  as  the  natural  sciences,  had  fallen  into  the  most 
complete  neglect. 

However,  toward  the  end  of  the  eleventh  century,  the  enthusiasm  of 
the  Crusades  offered  a  new  aliment  to  the  turbulent  ambition  of  the 
Christian  Barons.  But  while  the  higher  and  inferior  lords  of  western 
Europe  carried  their  bellicose  humor  to  the  East,  the  people,  though 
always  oppressed,  began  to  breath  freer ;  a  few  States  recovered  their 
independence  ;  the  reign  of  law  was  slowly  established ;  municipal  insti- 
tutions were  organized  and  consolidated,  and  establishments  consecrated 
to  public  instruction  Avere  multiplied  and  acquired  importance.  Finally, 
in  the  course  of  the  thirteenth  and  fourteenth  centuries,  the  darkness 
which  covered  the  face  of  Roman  Catholic  Europe,  began  to  give  way ; 
a  few  men  of  talent,  and  even  genius,  appeared  on  the  horizon  of  letters 
and  science,  though  all  is  in  obscurity  around  them — they  shone  in  the 
midst  of  their  ignorant  cotemporaries,  like  the  stars  that  glow  in  the 
firmament  before  the  appearance  of  Aurora.  Such,  in  letters,  were 
Dante,  Petrarch,  Boccacio,  whose  writings  recall  the  good  taste  and  purity 
of  the  happiest  ages  ;  such,  in  mathematics,  was  Leonard  of  Pisa,  who 
was  the  first  in  Europe  to  understand  and  employ  the  Arabic  figures  and 
algebraic  characters.'-' 

"  Cuvier  attributes  the  honor  of  this  importation  to  Gerbert,  a  learned  Benedic- 
tine of  the  tenth  century,  who  wore  the  tiara  under  the  name  of  Sylvester  II. — 
His.  des  Scien.  Nation.;  Paris,  1841,  t.  i,  pp.  396. 


MEDICINE   OP  THE   LATINS.  271 

The  physical  sciences,  also,  had  representatives  at  that  epoch,  when 
the  questions  of  scholastic  philosophy  and  theology  had,  almost  alone, 
the  privilege  of  engaging  the  human  mind.f  Koger  Bacon,  by  the 
force  of  his  genius,  was  in  advance  of  the  scientific  reform  which  was 
accomplished  three  centuries  later.  He  attempted  to  introduce  the 
experimental  philosophy ;  and  he  succeeded  so  well  in  communicating  to 
his  auditors  the  convictions  with  which  he  was  penetrated,  that  they 
subscribed,  in  equal  shares,  the  sum  of  two  thousand  pounds  sterling,  to 
provide  for  the  expenses  of  his  experiments.  It  was,  unquestionably, 
money  well  employed,  and  served  to  make  a  prodigious  number  of  dis- 
coveries for  such  an  age.  Thus,  it  is  said,  that  Bacon  knew  the  prop- 
erties of  convex  and  concave  glasses,  and  was  the  first  to  conceive  the 
idea  of  making  microscopes  and  telescopes.  His  astronomical  observa- 
tions led  him  to  demand  a  reform  of  the  calender,  which  was  executed 
three  centuries  later,  under  Gregory  XIII,  He  had,  also,  some  knowl- 
edge of  gunpowder  and  its  effects ;  in  short,  he  rejected  the  physics  of 
Aristotle.  So  much  boldness  and  superiority  could  not  fail  to  draw 
down  upon  him  persecution ;  he  was  condemned  to  imprisonment  for  life, 
by  the  chief  of  the  Grey  Friars,  and  to  live  on  bread  and  water ;  but  he 
was  brought  forth  in  1266,  on  the  demand  of  Pope  Clement  IV.  He  left 
a  large  number  of  works,  of  which  several  still  exist,  but  only  in  manu- 
script, the  friars  having  always  forbidden  their  publication,  because  they 
believed  them  to  be  tainted  with  magic  and  sorcery. 


ART.     I.      THE    MEDICAL    ORGANISATION     OF    THE    WEST. 

We  have  seen  what  was  the  medical  organisation  of  the  Boman 
Empire,  down  to  the  seventh  century.  The  palatine  archiaters,  attached 
to  the  palace  of  the  prince  ;  the  popular  archiaters,  forming  in  each  city 
a  college,  charged  with  the  sanitary  police,  and  the  instruction  and 
and  examination  of  aspirants  to  the  practice  of  medicine,  and  required 
to  give  gratuitous  attention  to  the  afflicted  poor ;  such  is  the  sum  of 
the  positive  knowledge  we  possess  on  the  subject,  down  to  the  destruction 


t  The  philosophers  were  at  that  time  divided  into  two  camps,  under  the  names 
of  Realists  and  Nominals.  The  first  believed  with  Plato,  that  ideas  are  self-existent 
and  independent  of  the  mind — that  they  are  veritable  entities ;  the  second,  on  the 
contrary,  affirmed  with  Aristotle,  that  general  ideas  are  pure  abstractions,  which 
our  minds  form  by  the  aid  of  sensations,  and  which,  without  these,  could  never 
exist.  These  two  sects  kept  up  a  very  active  war ;  and  as  they  called  to  their  aid 
the  civil  and  ecclesiastical  authority,  the  result  was  persecution  against  each 
other,  according  as  either  party  had  momentarily  the  power. 


272  ARABIC    PERIOD. 

of  the  school  of  Alexandria.  It  is  probable  that  after  the  ruin  of  this 
celebrated  school,  the  same  medical  organisation  subsisted  in  those 
provinces  which  continued  to  form  a  part  of  the  Greek  Empire  of 
Constantinople. 

In  those  countries  subjected  to  Arab  sway,  we  are  ignorant  of  what 
rules  existed  regulating  the  practice  of  Medicine.  We  know,  only,  that 
schools  and  academies  were  founded  in  several  cities,  for  the  teaching  and 
perfection  of  the  art ;  but  we  have  nothing  positive  on  the  interior  regi- 
men of  the  schools  and  academies,  or  the  degrees  that  were  conferred  by 
them,  and  the  manner  in  which  they  ascertained  the  capacity  of  the 
aspirants  to  academical  titles.  These  countries,  as  we  have  already 
said,  did  not  long  enjoy  an  enlightened  and  liberal  government.  From 
the  moment  that  they  fell  under  the  yoke  of  the  Turks,  they  lost  the 
greater  part  of  their  scientific  institutions,  which  have  not  since  been 
resuscitated;  and,  if  one  may  judge  by  what  still  exists  to-day  in  those 
unfortunate  countries  consumed  by  the  leprosy  of  ignorance  and  despot- 
ism, the  most  complete  medical  anarchy  followed  the  old  organization. 

In  Europe,  things  took  a  difierent  course.  At  first,  the  invasion  of 
the  barbarian  threw  every  thing  into  disorder  and  confusion.  The 
Christian  states  of  the  west  presented,  during  three  or  four  centuries,  a 
chaotic  condition.  The  sovereigns  of  these  states,  constantly  occupied 
with  the  care  of  self-defense,  or  the  desire  of  usurping  the  heritage  of 
their  neighbors  and  relatives,  scarcely  dreamed  of  bestowing  upon  the 
people  useful  laws  and  institutions ;  or,  if  any  among  them  wished  to 
labor  for  the  happiness  of  their  subjects,  all  their  plans  were  paralyzed 
by  a  multitude  of  obstacles  that  prevailed  within  as  well  as  without. 
In  the  midst  of  these  circumstances,  the  ecclesiastic  schools,  placed  under 
protection  of  the  bishops,  preserved,  alone,  a  course  of  literary  and  sci- 
entific instruction.  In  the  time  of  Charlemagne,  the  colleges  of  the 
cathedrals  and  some  monasteries  taught  Medicine,  in  a  limited  way, 
under  the  name  of  physics.  In  this  way,  all  the  liberal  professions,  and 
the  practice  of  Medicine  in  particular,  fell  into  the  hands  of  the  clergy. 
We  see  priests,  abbots,  and  bishops  become  the  physicians  of  kings. 
The  monks  of  Mount  Cassin,  of  the  order  of  St.  Benoit,  enjoyed,  for  a 
long  time,  a  great  reputation  for  skill  in  Medicine.  Among  others  are 
cited  Berthier,  abbot  of  this  convent,  in  the  ninth  century ;  Didier,  who 
wore  the  tiara  toward  the  close  of  the  eleventh  century,  under  the  name  of 
Victor  III.;  and  Constantine,  called  the  African,  of  whom  I  shall  speak 
presently,  when  on  the  subject  of  the  school  at  Salerno.  Among  the  num- 
ber of  ecclesiastics  who  distinguished  themselves  by  their  knowledge  of 
Medicine,  from  the  ninth  to  the  eleventh  centuries,  must  be  mentioned 
Hugues,  abbot  of  St.  Dennis,  who  was  physician  to  the  king  of  France ; 


MEDICINE   OF  THE   LATINS.  273 

Didon,  abbot  of  Sens;  Sigoal,  abbot  of  Epernay;  Mile,  archbishop  of 
Benevent,  and  others.  Finally,  several  religious  orders  of  women  in- 
gratiated themselves,  also,  in  the  practice  of  Medicine,  and  Hildegarde, 
abbess  of  the  convent  of  Eupertsburgh,  near  Bingen,  is  mentioned  as 
the  authoress  of  a  treatise  on  materia  medica.'--' 

From  the  ninth  to  the  thirteenth  century,  the  Jews  shared  with  the 
clergy  the  monopoly  of  the  healing  art.  The  knowledge  that  several  of 
them  had  acquired  of  the  Arabic  tongue,  by  the  commerce  they  held 
with  the  Saracens,  facilitated  their  study  of  the  medical  works  of  that 
nation,  which  stood,  at  that  time,  at  the  head  of  civilization ;  also,  not- 
withstanding the  canons  of  the  church  which  forbade  the  Israelites  from 
prescribing  or  administering  remedies  to  a  Christian,  they  were  obliged 
to  call  upon  them  in  time  of  need,  and  the  Jew  had  access  not  only  to 
the  courts,  but  also  to  the  palace  of  the  Pioman  pontiiFs. 

The  education  of  these  Christian  or  Jewish  medicasters,  clergy  and 
laiety,  embraced  generally  but  a  very  few  things  ;  it  consisted,  often,  in 
the  possession  of  some  recipes  and  the  knowledge  of  a  few  symptoms. 
The  extreme  rarity  of  books,  and  the  absence  of  capable  professors,  ren- 
dered a  good  medical  education  entirely  impossible.  We  may  form  an 
idea  of  what  was,  at  that  epoch,  the  teaching  of  Medicine,  when  we 
learn  that,  in  the  thirteenth  century,  John  of  Gaddesden,  the  author  of 
the  Rosa  Anglicana,  an  informal  collection  of  odd  formulse,  was  the 
oracle  of  the  University  of  Oxford,  the  doctor  a  la  mode  of  the  court  of 
England ;  and  that,  about  the  same  time,  Bernard  de  Gordon,  the  author 
of  Lilium  Medicince,  a  work  of  the  same  character  of  the  Rosa  Angli- 
cana, shone  in  the  first  rank  among  the  professors  of  Montpelier.  Guy 
de  Chauliac  thus  speaks  of  the  work  of  Gaddesden ;  "  Finally  appeared 
a  pale  English  rose,  which  was  sent  to  me,  and  I  perused  it.  I  did 
hope  to  find  in  it  sweetness  of  perfume ;  but  I  only  found  the  fables  of 
the  Spaniard  Gilbert  and  of  Theodorus."f  M.  Malgaigne  esteems  this 
critic  too  severe ;  but  he  does  not  show  himself  very  indulgent  in  regard 
to  a  man  who  dishonored  his  ecclesiastical  character,  and  his  character 
of  physician,  by  the  juggleries  of  the  most  impudent  charlatanism ;  of 
a  man  who  took  pleasure  in  displaying  the  shame  of  his  most  illicit 
gains.  The  following  among  his  acts  is  one  that  will  excite  most 
hilarity :  he  speaks  of  having  sold,  at  a  high  price,  to  the  barber-sur- 
geons, a  recipe  for  a  preparation  of  green  frogs,  and  boasted  of  having 
duped  them. I     What  confidence  could  this  vender  of  secret  remedies 

'-  See  Histoire  de  la  Medicine,  by  Sprengle,  translated  by  Jourdan,  T.  II,  p.  351' 
et  8uiv. 

t  La  Grande  Chirurgie  de  Guy  de  Chauliac,  restored  by  Laurent  Joubert,  Rouen, 
1632,  p.  10. 

J  Freind,  Hist.  Med.,  Paris,  1728,  quarto  ed. 


274  ARABIC   PERIOD. 

inspire  ? — this  constant  puflPcr  of  a  multitude  ofridiculous  proceedings, 
to  whom  all  means  of  gaining  money  appeared  equally  good. 

No  law,  no  rule  of  public  administration,  had  for  its  object  to  insure 
the  capacity  of  individuals  who  aspired  to  the  medical  profession.  Each 
one  at  liis  risk  and  peril,  entered  upon  the  cure  of  diseases ;  also,  besides 
the  priests  and  the  Jews,  who  stood  at  the  top  of  the  scale,  there  was  still 
a  multitude  of  healers  and  practitioners  of  the  lowest  order,  such  as  bath 
keepers,  barbers,  and  resuscitators,  and  even  a  few  women.  The  morality 
of  this  vulgar  medical  mass  was  on  a  level  with  its  knowledge,  as  is 
proven  by  a  law  of  Theodoric,  king  of  the  Visi-Goths,  which  code  was 
in  force  in  the  greater  part  of  the  West,  from  the  sixth  to  the  twelfth 
century.  This  law  says  that  no  physician  could  bleed  a  woman,  or  a 
daughter  of  noble  birth,  without  the  assistance  of  a  relative  or  a  domes- 
tic, and  in  case  of  contravention,  he  should  pay  a  penalty  of  ten  sous, 
quia  difficilUmum  non  est  ut  in  tali  occasione  ludihrium  interduvi  adhce- 
rescat.  When  a  physician  is  called  to  treat  a  disease  or  dress  a  wound, 
it  is  necessary,  immediately  after  having  seen  the  patient,  to  give  secu- 
rity and  agree  upon  the  price  of  his  attention.  If  he  happen  to  harm  a 
gentleman,  he  must  pay  a  forfeit  of  one  hundred  sous,  and  if  the  patient 
died  from  the  eifects  of  his  operations,  he  should  be  handed  over  to  the 
relatives  of  the  deceased,  who  could  do  with  him  whatever  they  pleased. 
If  in  any  way  he  crippled  a  serf,  or  caused  his  death,  he  was  held  account- 
able for  the  restoration  of  another  to  the  lord." 

We  see  by  the  above  guarantees  of  knowledge  and  morality  which 
were  required  of  the  aspirant  to  the  medical  profession,  that  the  legisla- 
tor held  in  constant  suspicion  all  who  devoted  themselves  to  its  practice. 
It  is  possible,  as  M.  Malgaigne  observes,  that  these  severe  restraints 
were  only  applicable  to  surgical  cases,  the  practice  of  which  was  at  that 
time  abandoned  to  individuals  of  the  lowest  conditions,  against  whom 
the  law  might  and  should  show  itself  suspicious ;  while  the  practice  of 
internal  medicine  formed  part  of  the  privileges  of  the  clergy,  who  alone 
were  the  depositories  of  letters  and  science,  and  enjoyed  the  highest 
consideration.  It  is  not  probable  that  the  secular  power  ever  dreamed 
of  handing  over  to  the  relatives  of  the  dead,  a  man  protected  by  the  title 
of  clergyman.! 

It  is  probable  that  it  was  from  this  time,  i.  e.,  from  the  seventh  cen- 
tury, that  Medicine  was  separated  from  Surgery.  This  change,  which 
was  contrary  to  the  views  of  the  greatest  masters,  and  which  in  itself 


'■'Lindenbrog,  Cod.  Leg.  Antiq.  Wisigoth,  lib.  xi,  tit.  i.     Sprengel  Hist,  de  la 
Med.,  translated  by  Jourdm.     Paris,  181-5,  t.  II,  p.  49. 

tCEuvres  completes  d'Ambrose  Pare,     Paris,  1840,  t.  I,  introduction,  §  1. 


MEDICINE   OF   THE   LATINS.  275 

is  not  very  rational,  was  not  the  effect  of  any  civil  law,  but  the  gradual 
result  of  custom  caused  by  the  general  prohibition  against  the  spilling  of 
blood  by  ecclesiastics.  Nevertheless,  it  appears  that  the  practice  of  Medi- 
cine, though  thus  separated  from  the  practice  of  surgery,  led  to  such 
irregularities  in  the  manners  and  discipline  of  the  clergy,  that  from  the 
twelfth  century,  we  observe  the  councils  and  popes  interdict  its  practice 
under  the  most  severe  menaces,  by  men  in  holy  orders  and  bound  by 
monastic  vows,  and  yet  this  prohibition  was  often  violated,  as  is  attested 
by  the  frequent  reiteration  of  this  law.-' 

In  the  course  of  the  twelfth  century,  the  secular  authority  began  also 
to  be  moved  by  the  abuses  which  had  entered  into  the  practice  of  Medi- 
cine. Eoger,  founder  of  the  kingdom  of  Sicily,  and  one  of  the  greatest 
men  of  his  time,  seems  to  have  been  the  first  among  Christian  princes  of 
the  Middle  Ages,  who  occupied  himself  with  this  subject.  In  1140,  he 
published  an  ordinance,  by  which  every  man  who  wished  to  devote  him- 
self to  the  practice  of  Medicine  in  his  State,  was  obliged  to  present 
himself  before  the  magistrate,  to  obtain  their  authorization,  under  pain 
of  imprisonment  and  the  confiscation  of  all  his  goods.  From  this  time, 
many  other  sovereigns  followed  his  example,  and  established  ordinances 
to  regulate  the  practice  of  Medicine.  In  the  end,  the  medical  organiza- 
tion was  completed  by  the  institution  of  faculties  and  university  degrees. 


ART.    II.     SCHOOL    OF    SALERNO. 

The  origin  of  this  school,  so  celebrated  in  the  Middle  Ages,  is  some- 
what obscure.  The  common  opinion  carries  it  back  to  the  epoch  of  the 
destruction  of  the  library  of  Alexandria,  by  the  Arabs.  It  is  pretended 
that  after  this  mournful  event  for  the  sciences,  the  professors  and  phy- 
cians.  who  were  very  numerous  in  that  city,  were  scattered  in  different 
countries ;  that  some  sought  refuge  at  Salerno,  where  they  laid  the 
foundation  of  a  medical  school,  which  grew  rapidly.  It  had  already  a 
reputation,  as  early  as  the  eighth  century,  but  the  epoch  of  its  great- 
est splendor  was  from  the  tenth  to  the  thirteenth  century. 

Several  circumstances  concurred,  at  this  time,  to  secure  to  it  extra- 
ordinary eclat :  first,  the  number  and  skill  of  its  professors,  who  were 
unquestionably  the  most  capable  in  all  Christendom ;  in  the  second 
place,  the  unexceptional  situation  of  the  city  of  Salerno,  lying  in  the 
route  which  travelers  had  almost  necessarily  to  follow  in  passing  from 
Europe  to  Asia,  and  of  the  fleets  that  transported  the  armies  of  the 

"Sprengel,  Hist.  Med.,  by  Jourd.,  t.  II,  p.  350. 


276  ARABIC   PERIOD. 

Crusaders.  This  city  offered  to  pilgrims  and  warriors  a  safe  haven ;  a 
delicious  and  salubrious  climate ;  all  the  means  and  recreations  which 
most  contribute  to  the  establishment  of  health  and  the  oblivion  of  every 
species  of  fatigue  and  suffering  which  they  had  encountered. 

The  reputation  of  its  medical  school  attracted  those  who  had  diseases 
or  wounds  difficult  of  cure,  from  all  parts  of  Europe.  Robert,  Duke  of 
Normandy,  the  son  of  William  the  Conqueror,  stopped  there  on  his 
return  from  the  Crusades,  to  be  treated  for  a  wound  of  the  arm.  John 
of  Milan  composed  for  his  benefit  a  summary  of  the  hygienic  aphorism 
of  the  school,  which  was  published  in  1100,  with  the  title  of  "  Dietetic 
Precepts  of  the  School  of  Salerno,"  and  made  much  noise  in  the  world. 
This  compilation  was  honored  by  several  commentaries,  the  most  famous 
of  which  is  that  of  d'Arnaud  de  Villeneuve.     It  begins  as  follows : 

"  The  faculty  of  Salerno  wrote  to  the  king  of  England  as  fol- 
lows: If  you  wish  good  health,  banish  despondency  and  avoid 
anger.  Drink  but  little  wine ;  eat  light  suppers,  and  do  not  disdain  to 
take  some  exercise  after  meals.  Do  not  sleep  during  the  day.  Do  not 
retain  too  long  the  urine  and  evacuations  from  the  bowels.  By  observing 
these  precepts,  your  life  will  be  prolonged.  "=•'  , 

Among  the  professors  of  the  school  of  Salerno,  the  most  illustrious  was 
Constantino  of  Carthage,  surnamed  the  African.  He  flourished  during  the 
latter  half  of  the  eleventh  century.  While  yet  young,  the  desire  for 
knowledge  urged  him  to  travel.  He  passed  through  Arabia,  Persia,  India, 
Egypt,  Ethiopia,  and  all  the  countries  where  any  knowledge  could  be 
gained.  On  his  return  to  his  country,  in  place  of  the  honors  he  had  a 
right  to  expect,  he  found  only  persecutions ;  he  was  looked  upon  as  a 
magician,  and  came  near  being  put  to  death,  but  escaped  and  took  refuge 
at  Apulia,  near  the  Duke  Robert  Guiscard.  who  made  him  his  secretary. 
Afterward,  he  was  adjunct  professor  in  the  College  of  Salerno,  and  taught 
Medicine  for  some  time  in  that  capacity.  Finally,  disgusted  with  the 
world,  he  retired  to  the  monastery  of  Mount  Cassin,  where  he  found  a 
safe  retreat,  where  he  could  indulge,  without  distraction,  in  his  penchant 
for  study.  While  there,  he  translated  and  compiled  a  great  number  of 
the  medical  works  of  the  Greeks  and  Arabs,  compilations  extremely 
useful  at  an  epoch  when  the  originals  could  not  be  read,  and  which 

"•'  Anglorum  regi  scripsit  schola  tota  Salerni : 
Si  vis  incolumen,  si  vis  te  reddere  sanum, 
Curas  toUe  graves ;  irrasci  crede  profanuin. 
Parce  mero ;  cenato  parum ;  non  sit  tibi  vanum 
Surgere  post  epulas.     Somnuni  fuge  meridianum. 
Non  mictum  retine,  nee  comprime  fortitei"  anum. 
Haec  bene  si  servas,  tu  longo  tempore  vives. 

Regimen  Sanitatis  Salerni,  Paris,  1493. 


MEDICINE   OF  THE   LATINS.  277 

contributed  powerfully  to  popularize,  in  Europe,  the  letters  and  science 
of  the  East.  Though  written  in  barbarous  Latin,  the  translations  of 
Constantino  served,  in  a  very  efficacious  manner,  for  the  propagation  of 
medical  knowledge  in  those  ignorant  times. 

In  the  course  of  the  thirteenth  century,  the  Emperor  Frederic  II., 
grandson  of  Eoger,  issued  an  edict,  in  virtue  of  which  no  individual 
could  practice  Medicine,  in  the  Kingdom  of  Xaples,  who  had  not  been 
examined  previously,  and  created  a  master,  by  the  College  of  Salerno. 
To  effect  this,  he  must  study  logic  three  years,  and  pursue  a  course  in 
Medicine  which  must  continue — (including  surgery,  which  made  a  part 
of  Medicine) — five  years,  according  to  the  interpretation  of  Sprengel, 
and  two  years  only  according  to  that  of  Malgaigne."  However  this 
may  be,  to  have  been  admitted  to  an  examination  at  the  end  of  term, 
the  student  must  furnish  a  ce»tificate  of  his  legitimate  birth,  and  that 
he  had  attained  his  twenty-fifth  year,  or  his  twenty-first  according  to 
another  version ;  after  which  he  was  examined,  publicly,  on  the  thera- 
peutics of  Galen,  the  first  book  of  Avicenna,  and  the  aphorisms  of  Hip- 
pocrates. These  proofs  being  satisfactorily  fulfilled,  he  took  an  oath  to 
be  faithful  to  good  conduct,  to  submit  to  the  rules  of  the  profession,  to 
give  gratuitous  attention  to  the  poor,  and  not  to  share  in  the  profits  of 
the  apothecaries.  His  diploma  was  afterward  to  be  confirmed  or  legal- 
ized by  an  officer  of  state ;  still  he  could  not  enter  fully  into  practice, 
but  was  obliged  to  continue  a  year  longer  under  an  experienced  physician. 

He,  who  wished  to  devote  himself  exclusively  to  surgery,  was  obliged  to 
follow  the  teachings  of  the  faculty  for  one  year  only ;  but  he  must  devote 
himself,  above  all,  to  acquiring  anatomy,  without  which,  said  the  act,  he 
could  not  safely  perform  any  surgical  operation,  nor  direct  the  subsequent 
treatment.  Afterward,  he  underwent  an  examination  which  gave  him 
authority  to  practice,  and  take  the  title  of  master.  Thus,  says  M.  Mal- 
gaigne,  there  were  two  masterships :  one,  which  gave  the  right  to  prac- 
tice medicine  and  surgery ;  and  the  other,  which  conferred  the  right 
to  practice  surgery  only. 


ART.    III.    ON    THE  ORIGIN    AND    GROWTH    OF    UNIVERSITIES. 

§1. 

In  the  times  of  Charlemagne,  as  before  observed,  each  cathedral  pos- 
sessed a  school,  where  writing,  arithmetic,  singing,  theology,  and  some- 
times, also  Medicine,  were  taught.     The  Episcopal  College,  of  Paris,  had 

-  Lindenbrog,  Constit.  de  Naples  et  de  Sicile,  liv.  iii,  chap,  xxxrv. — Sprengel, 
Histoire  de  la  Medicine,  sec.  7,  chap,  u,  T.  II,  p.  363. — M.  Malgaigne,  (EuvreB 
d'A.  Pare,  introduc,  §  4,  p.  30. 


278  ARABIC   PERIOD. 

medical  teachers,  who  gave  advice  and  dressed  wounds  before  the  portals 
of  Notre  Dame,  or  even  in  the  interior  of  the  church.  The  same  thing 
was  done  in  several  other  cities ;  but  when  the  medical  profession  had 
been  declared  incompatible  with  the  sacerdotal  office,  by  a  series  of 
councils,  the  popes,  in  order  to  preserve  the  high  jurisdiction  which  they 
had  exercised  from  time  immemorial  over  the  medical  corps  and  the  bar, 
erected  certain  Episcopal  schools  into  universities,  combining  at  once 
instruction  in  philosophy,  theology,  law,  and  medicine,  or  only  some  one 
of  these  faculties.  Thus  were  created  during  the  thirteenth  century, 
the  most  of  the  great  universities  of  Christian  Europe ;  among  others, 
those  of  Bologna,  Padua,  and  Naples,  in  Italy ;  those  of  Paris,  Mont- 
pelier,  and  Toulouse,  in  France ;  those  of  Valencia  and  Tortosa,  in 
Spain,  and  that  of  Oxford,  in  England.  Pope  Innocent  III.,  issued  a 
bull  which  guarantied  the  professors  and  students  of  Paris  from  all 
excommunication  which  should  not  proceed  directly  from  the  Holy  See. 
Other  bulls  confirmed  and  extended  these  immunities.  The  kings  of 
France,  themselves,  assumed  the  honor  of  conferring  special  privileges 
ujion  the  universities  of  their  capital,  to  such  an  extent  that  very  soon 
the  members  of  the  university  formed  in  the  midst  of  Paris  a  second 
city,  having  laws,  customs,  police,  inhabitants,  and  magistrates,  differ- 
ing from  those  of  the  rest  of  the  city.  "  All  science,"  says  M.  Mal- 
gaigne,  "  appertained  to  the  clergy,  and  teaching,  though  removed  from 
the  cloister,  did  not  become  less  Roman  Catholic.  These  new  clergy- 
men, connected  to  the  Chief  of  the  Church  by  their  oaths  and  privileges. 
were  unto  him  a  numerous  and  powerful  militia,  and  while  by  the 
clergy  proper  the  popes  reigned  over  the  consciences  of  the  people,  by 
the  clergy  of  the  universities  they  reigned  over  their  minds.  Who 
can  be  astonished,  then,  that  they  bore  impatientl}^  the  fact  of  not  being 
able  to  concentrate,  also,  all  other  powers  in  their  hands  ?"*  Neverthe- 
less, we  must  do  justice  to  the  pope,  the  monks,  and  the  Catholic  clergy 
in  general,  who  prepared  the  intellectual  movement  of  modern  Europe. 
The  universities,  by  associating  together  studious  men,  offered  them  the 
opportunities  and  means  of  mutual  instruction,  excited  their  emulation 
by  the  prospect  of  honors  and  rewards — concurred,  in  short,  in  a  very 
efficacious  manner  to  elevate  Christian  civilization,  above  all  others. 

.  The  great  eflfects  of  these  liberal  institutions  were  not  immediately 
realized,  it  is  true ;  it  required  several  generations  to  develop  their 
results,  and  ripen  their  fruits.  On  this  account,  the  end  of  this  his- 
toric period,  though  less  barbarous  than  its  beginning,  has  transmit- 
ted to  us  but  very  few  writers  worthy  to  arrest  our  attention.     The  men 


ffiuvres  d'A.  Pare,  introduction,  p.  28, 


MEDICINE   OF  THE   LATINS.  279 

who  made  themselves  a  reputation  in  the  sciences,  and  especially  in 
Medicine,  shone  less  by  the  merit  of  their  works,  than  by  the  love  for 
instruction,  and  by  the  zeal  which  they  displayed  in  its  research  and 
propagation.  To-day,  when  literary  riches  abound,  we  can  with  diffi- 
culty form  an  idea  of  the  price  they  cost  our  ancestors.  We  are  aston- 
ished to  see  them  undertaking  expensive,  as  well  as  wearisome  voyages, 
without  any  encouragement  or  hope  of  remuneration,  to  obtain  some 
manuscript,  or  hear  some  renowned  professor.  Such  was  the  devotion 
and  zeal  of  the  greater  part  of  the  authors  of  whose  lives  and  labors 
we  now  proceed  succinctly  to  speak. 

§n 

The  first  who  presents  himself  is  Gerard  de  Cremona,  in  Lombardy. 
"  You  will  seek  in  vain,"  says  M.  Malgaigne,  "the  name  of  Gerard  in 
the  historical  medical  dictionaries ;  he  has  been  rejected  even  by  many 
others,  and  yet  there  are  few  sciences  which  do  not  owe  him  some  grati- 
tude. A  man  of  study  and  piety,  he  had  ardently  perused  all  that  the 
Latin  authors  could  teach  him,  but  not  having  been  able,  in  Italy,  to 
procure  the  Almageste  of  Ptolomy,  he  determined  to  go  in  search  of  an 
Arabian  translation,  at  Toledo.  He  was  not  acquainted  with  the  Arabic, 
but  he  learned  it,  and  armed  with  this  powerful  resource,  which  none  of 
the  Occidentals  since  Constantino  the  African  had  possessed,  he  could 
not  see  before  him  so  many  Arabic  works  on  all  the  sciences,  without 
feeling  an  intense  desire  to  transmit  them  to  the  Latins,  as  to  a  cherished 
heiress,  says  his  naive  biography,  and  the  rest  of  his  life  was  occupied 
in  translations.  Among  a  mass  of  his  translations  are  found  those  of 
some  of  the  treatises  of  Hippocrates  and  Galen;  the  work  of  Serapion, 
the  books  of  Ehazes  to  Almansor,  the  immense  canon  of  Avicenna,  and 
the  treatise  on  surgery,  by  Albucasis.  He  died  at  Cremona,  in  1187, 
at  the  age  of  seventy-three,  and  left  all  his  books  to  the  convent  of 
Saint  Lucy,  in  which  he  was  buried. "••■^ 

William  of  Salicet  had  a  less  wandering  life.  Born  at  Plaisance, 
in  the  first  years  of  the  thirteenth  century,  he  was  professor,  at  first  at 
Bologna,  afterward  at  Verona.  It  does  not  appear  that  he  ever  quitted 
Italy.  Though  he  has  written  on  Medicine  and  Surgery,  it  is  especially 
as  a  surgeon  that  he  is  worthy  of  the  recollection  of  posterity.  He  is 
the  first,  in  that  period  of  ignorance,  who  wrote  on  that  branch  of  our 
Art  from  his  personal  experience,  and  who  has  not  always  followed. 
blindly,  the  opinions  of  his  masters.     He  died  in  1277  or  1280. 

Arnold  de  Villeneuve  was  a  man  passionately  fond  of  the  sciences. 
He  studied  ten  years  at  Montpellier,  twenty  years  at  Paris,  and  visited 

'^  CEuvres  of  d'A.  Pare.    p.  27. 


280  ARABIC    PERIOD. 

all  the  universities  in  Italy.  He  passed  into  Spain,  to  be  instructed  in 
the  Arab  works.  He  wrote  on  medicine,  theology  and  chemistry,  and 
enjoyed  considerable  reputation  among  several  sovereigns  and  popes. 
He  was  especially  renowned  as  a  chemist.  "  We  owe  to  him,"  says  M. 
Dezeimeris,  "  the  discovery  of  the  spirits  of  wine,  of  the  oil  of  turpen- 
tine, aromatic  waters,  and  some  other  preparations.  He  introduced  into 
medicine  the  use  of  chemical  remedies.  His  death  is  stated  to  have 
occurred  in  several  ways ;  but  it  is  generally  believed  to  have  taken 
place  in  1313,  when  he  went  from  Sicily  to  Avignon,  to  attend  upon 
Clement  V.,  who  was  sick."" 

Lanfranc  was  from  Milan,  and  studied  under  William  de  Sali- 
cet.  All  that  we  know  of  the  early  years  of  his  life,  is,  that  he 
practiced  surgery  in  that  city  at  the  time  of  the  greatest  dissensions  of 
the  Guelfcs  and  the  Gibelins.  The  party  to  which  he  was  attached  was 
the  weaker.  Matthew  de  Vincenti,  chief  of  the  other  party,  exiled  our 
surgeon.  He  went  to  seek  an  asylum  in  France,  and  stopped  first  at 
Lyons,  where  he  remained  several  years,  and  where  he  wrote  his  Minor 
Surgery.  In  1295  he  went  to  Paris,  and,  at  the  instance  of  John  Passa- 
rant,  dean  of  the  faculty  of  Medicine,  he  opened  a  course  on  Surgery, 
which  had  great  success.  It  was  then  that  he  achieved  his  Great 
Surgery,  which  was  published  in  the  following  year.  We  do  not  know 
the  period  of  his  death,  but  from  the  way  Henry  de  Mandeville  speaks 
of  him  in  1306,  we  suppose  he  was  not  then  alive. 

"  We  are,  unhappily,  compelled  to  add,"  observes  M.  Malgaigne,  "that 
in  the  hands  of  I^anfranc,  and  much  less,  doubtless,  from  his  fault  than 
by  that  of  his  age.  Surgery  began  to  decline.  We  have  seen  that  from 
the  times  of  Brunus  (who  practiced  in  Padua  in  1250),  the  barbers  did 
the  scarrifying  and  bleeding ;  from  the  times  of  Lanfranc  there  were 
others  who  applied  leeches,  and  what  is  much  more  serious,  even  caute- 
ries. The  women,  who  meddled  themselves  with  surgery,  in  all  these 
operations  competed  with  the  barbers.  On  the  other  hand,  the  lay- 
surgeons  held  themselves  as  the  rivals  of  the  clergy.  Lanfranc,  who 
had  inherited  for  them  all  the  aversion  of  his  master,  had  more  than  one 
contest  to  sustain  with  them  in  his  practice,  and  if  they  had  less  success, 
they  had  more  boldness.  The  clinical  surgeons  began  to  regard  the 
operations  as  too  much  beneath  them ;  Lanfranc,  who  deplored  these 
whims,  and  who  declared  that  he  sometimes  bled  with  his  own  hands, 
never,  however,  operated  for  ascitis,  hernia,  cataract  or  stone."'-' 


t  M.  Hoefer  denies  all  the  chemical  discoveries  attributed  te  this  physician,  and 
proves  that  they  were  anterior  to  him.     Hist,  de  laChimie ;  Paris,  1842. 
-' OJuvres  de  A.  Pare;  Paris,  1840,  Introduc,  §  G,  pp.  46. 


MEDICINE   OF  THE   LATINS.  281 

John  Pitard  was,  in  130G,  surgeon  of  the  King  of  France,  Phillip 
le  Bel,  and,  also,  the  sworn  surgeon  of  Chatelet.  He  has  left  no 
writings  on  his  art ;  but  he  is  regarded  as  the  founder  of  the  surgical 
school  of  St.  Come  and  St.  Damien,  which  occupies  so  eminent  a  position 
in  the  surgical  annals  of  France.  This  college,  which  was,  in  1311, 
only  a  little  brotherhood  of  lay-surgeons,  insensibly  increased  in  impor- 
tance, as  the  result  of  the  obstinate  struggle  which  they  sustained,  on 
one  hand  against  the  faculty  of  medicine — on  the  other  against  the 
barber-surgeons.  M.  Malgaigne,  who  has  unravelled,  with  the  patience  of 
an  erudite,  the  origin  and  title  of  this  community,  proves  that  at  first 
its  importance  was  greatly  exaggerated  by  its  historians.-'  Afterwards, 
on  another  occasion,  looking  especially  on  the  facetious  side  of  its  long 
quarrels,  he  has  traced  their  various  turns  of  fortune  in  the  comic 
vein  of  Aristophanes,  or  of  the  chorister  of  Lutrin.f 

Guy  de  Chauliac,  the  most  famous  of  the  physicians  and  surgeons  in 
Christendom,  during  the  Arabic  Period,  was  born  in  a  village  of  the  diocese 
of  Mende,  in  Gevaudan.  "  He  was  already  clerk,"  says  M.  Dezeimeris, 
•'  and  at  least  twenty-five  years  of  age,  in  1325.  In  this  way  we  fix  the 
epoch  of  his  birth  at  the  end  of  the  thirteenth  century.  It  is  supposed 
that  he  studied  the  humanities  in  the  College  of  the  Cathedral,  at 
Mende,  which  enjoyed,  at  that  time,  a  great  celebrity.  He  studied 
medicine  at  Montpellier.  Among  the  masters  he  heard,  he  cites  with 
gratitude  Eaimond  de  Molieres,  Pierre  de  Toulouse,  Pierre  d'Horlac  or 
d'Aurillac,  and  Master  Barthelemy,  or  Barthomieu,  called,  also,  Bertru- 
cius  or  Bertrand,  in  the  copies  printed  of  the  surgery  of  other  authors." 
It  is  probable  that  Guy  followed  the  course  of  the  faculty  of  Paris  ;  for  he 
recounts,  himself,  how  a  shoemaker  of  that  city  removed  a  corn  from  his 
foot.    He  studied,  also,  at  Bologne,  where  he  saw  several  dissections  made. 

"  Little  satisfied  with  the  science  drawn  from  the  schools,"  adds  his 
biographer,  "  Guy  de  Chauliac  made  himself  familiar  with  the  writings 
of  the  ancients,  and  acquired  an  erudition  infinitely  more  extended  than 
any  of  his  cotemporaries.  He  practiced  in  various  cities,  but  fixed  his 
residence  for  a  longer  time  at  Lyons  than  elsewhere.  He  entered  the 
service  of  Pope  Clement  YI.,  at  Avignon,  where  the  Holy  See  was  trans- 
ferred— at  latest  in  1348.  We  have  reason  to  believe  that  he  enjoyed 
the  same  honor  under  Innocent  V.,  at  the  death  of  whom  Guy  de  Chauliac 
was  welcomed  by  Urban  Y.,  his  compatriot,  who  was  crowned  Pope  in  1362; 
he  became  his  chaplain,  commencal  or  reader  in  his  chapel.  We  know 
not  the  length  of  time  he  enjoyed  that  dignity.     All  our  knowledge  on 

'*  (Euvres  d'A.  Pare,  §  16,  pp.  120. 

t  See  his  eleventh  letter  on  the  History  of  Surgery. 

18 


282  ARABIC   PERIOD. 

this  subject  comes  from  himself;  and  it  does  not  appear  that  he  wrote 
anything  after  1363,  at  which  time  he  published  his  Surgery. '■■' 

He  composed  several  works,  which  are  enumerated  by  M.  Malgaigne. 
but  the  only  one  which  requires  our  attention  now,  is  his  Great  Surgery, 
which  he  calls  Inventory,  to  signify,  as  he  explains,  that  it  contains  the 
succinct  exposition  of  all  that  was  essential,  that  had  been  taught  up  to 
that  time,  on  each  branch  of  the  art.  In  his  singular  chapter — capitu- 
lum  singulare — which  seems  as  an  introductory,  he  glances  at  the  pro- 
gress of  surgery  since  Hippocrates.  He  names  a  great  number  of  Greek, 
Arabian,  and  Latin  authors,  and  of  all  those  whose  writings  have  reached 
us,  he  omits  only  Celsus  and  Aetius.  He  cites  some  Arabian  physicians 
of  whom  we  have  no  knowledge  at  present.  No  one  has  known  better 
than  he,  how  to  unite  respect  for  the  ancients  with  justice  toward 
moderns.  "  The  sciences,"  he  remarks,  "  are  created  by  successive 
additions ;  the  same  man  can  not  lay  the  foundation,  and  perfect  the 
superstructure.  We  are  as  children  carried  on  the  neck  of  a  giant ; 
aided  by  the  labors  of  our  predecessors  we  see  all  that  they  have  seen, 
and  something  besides."  In  the  same  chapter,  in  tracing  the  character 
of  a  surgeon,  he  recommends  that  he  be  learned,  expert,  ingenious,  and 
bien  morigene,  that  is  to  say,  following  the  interpretation  that  be  gives 
himself  of  the  last  word :  that  he  be  bold  where  he  is  sure,  and  timid 
when  in  doubt ;  that  he  avoid  bad  cures  and  practices  ;  be  gracious  to 
the  sick  ;  generous  to  his  companions  ;  wise  in  predictions ;  chaste, 
sober,  pitiful,  and  merciful ;  not  covetous,  nor  an  extortionate  of  money, 
but  receive  a  moderate  fee,  according  to  his  labor,  the  abilities  of  his 
patient,  the  character  of  the  issue  or  event,  and  his  own  dignity. 
"  Never,  since  Hij^pocrates,"  exclaims  M.  Malgaigne,  "  has  Medicine 
heard  a  language  stamped  with  such  nobility,  and  in  so  few  words." 

The  entire  work  is  divided  into  seven  treatises  or  books.  The  first 
is  devoted  to  anatomy,  but  contains  nothing  new  ;  the  description  he 
has  given  of  the  body  is  drawn  entirely  from  Galen,  or  some  other 
nearer  and  less  pure  source.  But  he  insists  on  the  necessity  of 
dissections,  and  states  that  the  practice  had  been  introduced  for  some 
time,  in  the  school  at  Montpellicr,  of  making  anatomical  demonstrations 
on  animals.  He  proposes,  also,  to  make  use  of  the  corpses  of  executed 
criminals.  He  speaks  of  drawings  representing  parts  of  the  human 
body,  which  had  been  drawn  by  the  direction  of  Henri  d'Hermoudaville, 
or  Mondeville.  As  to  his  surgery  proper,  he  extracted  it  from  Galen, 
Oribasius,  Paul  dVEgina,  Ehazes,  Avicenna,  Albucasis,  Roger.  Roland, 
and  other  writers,  but  he  selects  from  them  with  discretion  ;  he  discusses, 

'  M  Dezeimeris  Dictiooinaire  de  Medicine,  article  Guy  de  Chauliac. 


MEDICINE   OF   THE   LATINS.  283 

judges,  chooses,  and  makes  summaries  of  their  opinions  and  methods. 
'•At  that  period,"'  says  M.  Dezeimeris,  "  an  inventor  would  have  rendered 
less  important  services  than  a  judicious  compiler.  Books  were  of  an 
extreme  rarity,  and  from  their  price  within  the  reach  of  but  few  sur- 
geons ;  to  unite  them  nearly  all  in  one,  to  collect  all  that  there  was 
useful,  so  as  to  form  but  one  small  volume,  was  to  place  the  science 
within  the  reach  of  all  fortunes,  to  give  facility  for  learning  to  him 
who  was  doomed  to  ignorance  by  the  scarcity  of  books,  and  to  create,  not 
surgery,  it  is  true,  but  surgeons.*' 

In  the  second  book^  which  treats  of  abscess,  our  author  gives  the 
word  a  more  extensive  meaning  than  it  has  at  this  time.  He  designates 
by  it  every  species  of  tumor,  excressence,  and  swelling,  partial  or 
general.  "  The  great  abscesses,"  he  remarks,  "are,  according  to  Galen, 
considerable  tumors,  which  are  developed  in  fleshy  parts.  The  little 
abscesses  are,  according  to  Avicenna,  eminences,  pustules,  and  pimples, 
which  appear  on  the  surface  of  the  skin.'"  He  divides  abscesses  into  hot 
and  cold.  The  hot  are  caused  by  too  much  blood,  such  as  the  phlegmon, 
anthrax,  gangrene,  and  pustules  :  sometimes  from  the  bile,  as  erysipelas, 
vessicles,  and  effervescences.  Amon^-  cold  abscesses  he  classed  oedema, 
tympanitis,  dropsies,  scrofula,  scirrhus,  and  cancer. 

The  practice  of  Guy  de  Chauliac,  though  timid,  was  more  active  than 
that  of  Lanfranc.  He  never  cut  for  stone  ;  he  left  to  the  travelling 
surgeons  that  operation,  which  he  desribes  according  to  the  Arabic 
writers,  and  as  he  had  seen  it  performed  ;  but  he  incised  the  abdomen, 
in  ascitis,  and  did  not  hesitate  to  attempt  the  radical  cure  of  hernia ; 
he  speaks  of  cataract  like  a  man  thoroughly  acquainted  with  it,  and 
who  had  operated." 

The  plague  which  raged  during  the  fourteenth  century  in  all  parts  of 
the  known  world,  and  which  depopulated  the  globe,  according  to  his- 
torians, of  a  fourth  of  its  inhabitants,  appeared  twice  in  the  city  of  Avig- 
non, at  the  time  Guy  resided  there.  He  acknowledges,  ingenuously, 
that  he  desired  to  fly,  like  others,  that  theater  of  death;  but  was 
prevented  by  the  shame  of  the  thing.  Et  ego,  he  says,  propter  infa- 
miam,  non  fui  ausus  recedere.  He  remained  at  his  post,  continuing  to 
visit  the  sick,  and  giving  them  consolations  as  well  as  counsels,  notwith- 
standing the  uselessness  of  remedies.  Being  attacked  himself,  he  saw 
all  abandon  him  and  leave  him  for  dead.  In  this  frightful  position,  he 
preserved  enough  presence  of  mind,  to  follow  the  progress  of  his  disease, 
analyze  his  suff'erings,  and  give  a  description  of  them,  worthy  of  Hippo- 
crates. 


*  M.  Malgaigne,  (Euvres  d'A.  Pare. 


284  ARABIC   PERIOD. 

Here  finishes  the  list  of  men  rendered  eminent  by  services  to  medical 
science  during  the  Arabic  period.  The  work  of  Guy  de  Chauliac  became 
very  soon  the  surgical  code  of  Europe ;  translated  and  commented  upon 
in  all  tongues,  and  reproduced  under  different  forms,  it  was  for  a  long 
time  classic,  and  still  preserves  its  interest,  as  representing  the  state  of 
science  at  the  close  of  the  middle  ages.  He  has  written,  moreover,  in  a 
clear,  concise,  and  even  picturesque  style,  very  superior  to  the  barbarous 
Latin  of  most  of  the  writers  of  his  time. 


CHAPTER    IV. 
ACCESSORY   INSTITUTIONS. 

Charitable  institutions  were  astonishingly  multiplied  during  this 
period,  as  well  among  the  sectators  of  Mahomet  as  in  the  Christian 
states.  By  the  side  of  each  mosque,  the  same  as  by  each  cathedral, 
there  were  usually  a  school  and  a  hospital,  endowed  with  more  or  less 
munificence  by  emperors,  califs,  kings,  bishops,  or  the  opulent,  who  hoped 
to  buy  a  redemption  from  their  sins  by  pious  liberality,  and  secure  an 
eternity  of  happiness.  A  great  number  of  religious  communities  were 
established  during  the  middle  ages,  to  give  succor  to  the  necessitous 
sick.  The  most  consideralile  were  the  orders  of  St.  Mary,  St.  Lazarus, 
the  Knights  of  St.  John  of  Jerusalem,  and  the  Daughters  of  God.  In 
the  end,  some  of  these  orders  departed  from  their  primitive  undertak- 
ings, and  became  so  rich  as  to  excite  the  covetousness  of  sovereigns,  and 
so  powerful  as  to  resist  their  authority.  More  than  once,  the  laxity  of 
morals  and  the  spirit  of  discord  entering  into  these  religious  societies, 
rendered  their  reform  or  even  their  suppression  necessary ;  but  in  their 
origin  all  had  an  aim  for  charity  and  sanctifieation. 

The  charitable  zeal  for  the  sick  was  never  more  fervent  than  at  this 
epoch;  we  see  princes,  bishops,  and  popes  give  an  example  of  heroic 
devotion,  in  dressing,  with  their  own  hands,  the  ulcers  of  the  leprous,  of 
which  no  one  at  that  time  had  doubted  the  contagious  properties ;  never, 
besides,  were  the  occasions  for  their  exercise  more  frequent.  The  leprosy 
that  the  crusaders  had  contracted  in  the  Orient,  spread  with  frightful 
rapidity  ;  misery,  uncleanness,  and  the  want  of  hygienic  care  had  multi- 
plied, to  the  last  degree,  cutaneous  diseases  of  every  species;  ignorance 
and  fear  aggravated  still  more  the  evil,  by  confounding  with  the  leprosy 
affections  of  a  nature  less  formidable ;  so  that,  in  the  thirteenth  century, 


ACCESSORY  INSTITUTIONS.  285 

it  was  estimated  that  there  were  not  less  than  two  thousand  leprous  per- 
sons in  France,  and  nineteen  thousand  in  Europe  entire. 

The  excessive  severity  of  a  mass  of  ordinances  enacted  against  the 
leprous,  proves  how  great  was  the  terror  which  that  hideous  disease  in- 
spired. They  were  forbidden  to  enter  the  cities ;  if  they  encountered 
any  one  in  their  walks,  they  were  compelled  to  turn  aside,  so  that  their 
breath  should  not  taint  them.  If  a  healthy  person  was  convicted  of 
having  touched  a  leper,  or  any  thing  which  they  had  been  using,  he 
was  immediately  separated  from  society.  Lastly,  the  least  infraction  of 
any  of  these  rules  entailed  severe  punishment,  often  even  that  of  death. 
What  superhuman  courage,  what  abnegation  did  it  not  require  in  those 
who  devoted  themselves  to  the  service  of  these  unfortunates  ! 

Another  institution,  which  would  tend  more  effectually  than  coercive 
measures  to  the  diminution  of  these  cutaneous  diseases,  was  that  of  pub- 
lic baths.  They  were  established  in  nearly  every  city,  and  the  number 
increased  to  such  an  extent  that,  in  the  fifteenth  century,  the  bathers 
formed  in  Paris  a  powerful  brotherhood. •■•^  Jaques  Despars,  physician 
to  Charles  VII.,  and  one  of  the  most  renowned  professors  of  the  faculty, 
having  spoken  too  openly  against  the  abuses  of  public  baths,  was  obliged 
to  quit  the  capital  to  avoid  the  persecutions  of  that  brotherhood. 

RESUME    OF    THE    ARABIC    PEPJOD. 

Three  grand  facts  predominate  in  the  history  of  this  period,  and 
reflect,  to  some  extent,  the  progress  of  the  human  mind. 

1.  The  Arab  nation,  until  that  time  obscure,  and  almost  a  stranger 
to  the  progress  of  civilization,  passed  rapidly  from  a  demi-sivage  to  the 
first  rank  of  polished  nations.  After  having,  for  several  years,  carried 
over  the  conquered  countries  the  fury  of  a  religious  vandalism,  they 
embraced,  with  enthusiasm,  the  culture  of  the  muses,  and  endeavored  to 
repair  their  early '  ravages,  by  collecting  the  debris  of  the  literary  and 
scientific  movements  of  Greece.  Medicine  is  one  of  the  sciences  which 
they  cultivated  with  most  zeal  and  success,  though  they  added  but  little 
to  the  treasures  amassed  by  the  genius  of  the  Greeks.  Very  soon  a 
people  more  barbarous  and  unknown,  issued  from  the  deserts  of  Tartary 
and  subjugated,  in  their  turn,  the  Arab  nation,  in  all  parts  of  the  world 
where  they  had  established  themselves,  enervated  them  under  a  brutal 
despotism,  and  degraded  them  to  a  state  akin  to  their  primitive  igno- 
rance.    Thus,  wherever  the  Turk  dominates,  humanity  retrogrades. 

"Sse  P.  S.  G(5rard,  Recherches  sur  les  etablissraents  de  Bains  Publics  a  Paris, 
from  the  fourth  century  to  the  present  time.  (Annales  d'Hygiene  Publique 
et  de  Me'dicine  Legale,  Paris,  1832,  T.  VII,  p.  5,  ct  suiv.) 


286  ARABIC   PEEIOD. 

2.  The  Greek  nation,  which  marched  for  so  many  ages  at  the  head 
of  civilized  nations,  is  stripped,  one  by  one,  of  the  gems  of  its  antique 
crown — power,  virtue,  courage,  glory,  independence,  all  successively 
pass  away.  It  descends  by  a  slow,  but  continued  degradation,  to 
the  lowest  rank  of  modern  nations.  In  the  course  of  this  period,  but  a 
single  physician  merits  a  historic  mention  on  account  of  his  writings, 
and  we  find  in  these  nothing  new,  with  the  exception  of  a  few  remedies 
borrowed  from  the  Arabians,  and  without  giving  credit  for  them. 

3.  1  he  western  part  of  the  Roman  Empire,  subjugated  by  the  barba- 
rians who  issued  from  the  forests  of  Germany  and  Scandinavia,  fell 
into  the  the  thickest  darknes  from  the  first  tiges  of  this  period ;  but  the 
inhabitants  of  these  unhappy  countries,  though  loosing  the  independence, 
order,  and  security  which  they  enjoyed  under  the  Eoman  institutions, 
preserved,  at  least,  their  manly  courage.  Their  blood  received  new  life 
by  being  mingled  with  that  of  the  rude  children  of  the  North.  They 
repulsed,  in  the  first  place,  the  Saracens,  who  poured  upon  them  like  a 
torrent  from  the  South  of  Spain.  Tranquil  on  that  side,  they  turn 
their  arms  against  each  other,  and  bring  ruin  upon  themselves  for  sev- 
eral centuries:  then,  excite!  by  religious  fanaticism,  as  were  formerly 
the  Mohamedans,  they  rushed  by  thousands  to  the  plains  of  Asia  Minor, 
Syria,  and  Egypt,  which  had  been  occupied  for  several  centuries  by  the 
Saracens.  These  distant  and  adventurous  enterprises,  the  aspect  of  an 
entirely  new  civilization,  inspired  the  Erancs  with  a  taste  for  poetry  and 
works  of  imagination,  then  in  great  honor  among  the  Arabs.  During 
the  twelfth  and  thirteenth  centuries,  the  governments  of  Europe  become 
regulated  and  stable,  liberal  institutions  are  created,  the  mind  of  the 
people  of  the  West  shakes  off,  gradually,  the  rust  of  ignorance,  and  at 
the  end  of  the  Arabic  period,  we  already  see  some  brilliant  streaks  of 
light  in  the  horizon  of  European  nations.  Medicine  participated  in 
this  progressive  movement.  Erom  the  fourteenth  century,  we  see  it 
worthily  represented  in  Italy,  in  Paris,  and  especially  in  3Iontpclier. 
Nevertheless,  physicians  as  yet  only  knew  how  to  follow,  timidly,  the 
track  of  the  Arabs ;  scarcely  any  of  them  had  approached  their  lips  to 
the  purer  sources  of  Greek  medicine. 

Here  I  close  the  Age  of  Transition,  or  the  middle  ages,  and  now  opens 
before  us  an  era  more  glorious,  which  we  may  salute  by  exclaiming  with 
the  poet,  "  Already  commences  a  new  order  of  famous  ages." 

Magnus  ab  integro  saeclorum  nascitur  ordo. 

ViRQ.     Edog. 


BOOK      III. 
.     AGE    OF    RENOVATION. 

EXTENDING  FROM  THE  COMMENCEMENT  OF  THE  FIFTEENTH  CENTURY 
TO  THE  PRESENT  TIME. 


VII.    ERUDITE   PERIOD, 

INCLUDING  THE  FIFTEENTH  AND  SIXTEENTH  CENTURIES. 
GENERAL     CONSIDERATIONS. 

This  age,  which  includes  a  space  of  a  little  more  than  four  hundred 
years,  or  only  about  one-third  of  the  duration  of  the  preceding  age, 
offer's,  nevertheless,  to  the  history  of  science  in  general,  and  that  of 
Medicine  in  particular,  much  more  abundant,  varied,  and  interesting 
materials.  The  mind  of  Occidental  Europe,  long  plunged  into  a  species 
of  torpor,  gi-adually  awoke,  and  seemed  to  have  acquired  by  the  repose 
an  extraordinary  vigor.  Soon  breaking  its  Gothic  bonds,  it  launched 
forth,  in  every  direction,  with  youthful  ardor;  some  remounting  the 
chain  of  ages  to  seek  the  debris  of  antique  science,  in  order  to  restore 
and  offer  to  it  a  species  of  worship ;  others  endeavored  to  associate  an- 
cient with  modern  ideas,  and  elevate  on  this  double  base  the  edifice  of 
human  knowledge  ;  others,  finally,  bolder  and  more  precipitate,  cut  loose 
from  the  past,  rejected  its  traditions,  and  assumed  to  build  the  scientific 
structure  with  new  materials  entirely. 

1  have  already  announced  some  of  the  circumstances  that  contributed 
to  the  awakening  of  the  mind  of  Europe ;  such  as  the  diminution  of  the 
internal  conflicts  between  the  princes  and  their  vassals,  a  better  social 
organization,  the  creation  of  establishments  calculated  to  disseminate 
knowledge,  etc.;  and,  I  must  add  here,  that  this  awakening  was  consid- 
erably favored   by  some  industrial  discoveries  of   capital  importance. 


288  ERUDITE   PERIOD. 

The  invention  of  the  compass,  for  example,  rendering  long  maritime 
voyages  less  dangerous  and  more  frequent,  opened  to  cosmography  and 
many  other  sciences  a  vaster  field.  By  the  aid  of  the  telescope,  astron- 
omy was  able  to  seize  some  of  the  most  scattered  rays  in  the  immensity 
of  the  skies ;  to  calculate  more  exactly  the  revolutions  of  celestial 
bodies ;  to  assign  to  our  globe  its  true  form,  and  to  the  sun  its  gigantic 
dimensions  and  legitimate  p/lace,  in  the  center  of  our  planetary  system. 
The  eye  of  the  naturalist,  armed  with  the  microscope,  penetrated  into 
the  domain  of  the  infinitely  minute,  and  perceived  there  a  multitude  of 
phenomena  which  the  ancients  had  not  even  suspected.  Engraving  on 
copper,  multiplying  almost  at  pleasure  the  chefs-d' ceuvre  of  painting  and 
drawing,  united  to  the  verbal  description  of  objects,  their  graphic,  and. 
if  we  may  say  so,  living  representation,  whenever  that  appeared  neces- 
sary, as  in  the  works  on  natural  history  and  anatomy. 

But  of  all  the  discoveries  that  inaugurated  this  modem  age,  and 
illustrated  its  commencement,  no  one  has  thrown  such  eclat  or  has  ex- 
ercised so  great  an  influence  on  the  development  of  ideas,  as  the  art  of 
printing.  After  writing,  nothing  has  been  found  to  the  present  time  so- 
favorable  to  the  transmission  of  thought,  as  the  typographical  art.  This 
art,  in  which  the  first  attempts  were  made  between  the  years  1435  and 
1440,  was  carried  from  its  origin  to  a  degree  of  notable  perfection  by 
the  united  efforts  of  three  industrious  men,  Guttenberg,  Faust,  and 
Shoeffer.  Thanks  to  their  ingenious  combinations,  language,  repeated 
an  infinite  number  of  times,  was  able  to  carry  ideas  and  light  even  to 
the  most  obscure  ranks  in  society.  Thence  the  triunsphs  of  intelligence 
and  reason  were  secured ;  thence  might  be  seen,  in  the  future,  more  or 
less  distant,  the  end  of  the  dominion  of  brute  force ;  for,  by  means  of 
this  happy  artifice,  thought  was  thereafter  to  be  as  imperishable  as 
its  source. 

At  the  beginning  of  the  erudite  period,  the  Arabic  literature  was  still 
predominant  in  the  school  of  Medicine.  The  only  authorities  that  were 
then  invoked  and  explained,  were  Bhazes,  Haly-Abbas,^  and  Avicenna. 
Jacques  Despars,  one  of  the  most  distinguished  professors  of  the  faculty 
in  Paris,  in  the  first  half  of  the  fifteenth  century,  distinguished  himself 
by  his  compilations  of  the  books  of  Avicenna  an^  Mesue.  The  taste 
for  Greek  literature  began,  however,  to  prevail  in  the  universities  of 
Italy,  and  finally  grew  so  as  to  be  extended  into  other  parts  of  Europe, 
after  the  taking  of  Constantinojde,  in  1483,  by  Mahomet  II.,  emperor 
of  the  Turks.  This  mournful  event,  which  seemed  to  be  a  mortal  blow 
to  the  Greek  language  and  literature,  hastened,  on  the  contrary,  their 
resurrection  in  the  Occident.  This  city  having  been  given  over  to  pill- 
age, a  large  number  of  learned  men  expatriated  themselves,  carrying 


HUMANIST   PHYSICIANS.  289 

away  all  the  manuscripts  tbey  were  able  to  save.  The  most  of  them 
sought  refuge  in  Italy,  where  they  found  enlightened  protectors  in  the 
all-powerful  princes  of  the  house  Medici,  in  Florence,  in  the  Koman 
pontiffs,  and  Alphonso  d'Aragon,  sovereign  of  Naples  and  Sicily.  These 
fugitives  made  their  hosts  acquaiuted  with  chefs-d'oeuvre  of  Greek  anti- 
quity, so  long  forgotten ;  and  paid  thus  their  adopted  country,  for  the 
hospitality  that  was  accorded  to  them,  by  disseminating  the  models  of 
a  good  literature.  Among  these  strangers,  who  contributed  the  most  to 
popularize  Greek  works,  history  gratefully  cites  the  names  of  Theodore 
Gaza,  Agryrophile,  and  Lascaiis. 

Thence  the  taste  for  books,  libraries,  and  sound  erudition  was  diffused 
throughout  Europe.  The  monuments  of  Greek  and  Latin  anti(j[uity 
were  hunted  up  and  published  with  indefatigable  patience  and  ardor ; 
A  mass  of  ancient  works  were  edited,  translated,  and  commented 
upon,  with  extreme  care,  and  a  great  number  of  these  translations  and 
commentaries  are  still  most  estimable.  The  authenticity  of  manuscripts 
and  purity  of  texts  were  discussed  with  sagacity  ;  and  efforts  were  made 
to  free  the  new  editions  from  faults,  omissions,  and  interpolations,  which 
had  glided  into  the  manuscript  copies  in  the  lapse  of  time,  by  the  igno- 
rance or  cupidity  of  the  copyists.  Scholars  of  the  first  merit  devoted 
themselves  to  this  wearisome  and  thankless,  though  eminently  useful, 
task ;  and  they  opened  for  their  successors  the  pathway  of  science,  and 
removed  the  obstacles  that  encumbered  it.  Let  thanks  be  rendered  to 
them. 

For  a  short  time,  now,  we  will  glance  at  the  labors  of  some  of  those 
laborious  critics  who  have  elucidated  for  us  the  memorials  of  antique 
Medicine. 


CHAP  TEE    I. 
HUMANIST    PHYSICIANS. 

1.  The  first  who  presents  himself  to  us  in  chronological  order,  is 
Nicholas  Leonicenus,  who  was  born  at  Lonigo,  near  Vincenza,  in  the 
year  1428.  He  studied  Medicine  at  Padua,  and  taught  it  for  more  than 
sixty  years  at  Ferrara.  His  lectures  and  his  numerous  writings  contrib- 
uted effectually  to  propagate  a  taste  for  a  sound  literature.  He  was 
the  first  to  translate  directly  from  Greek  into  Latin  the  Aphorisms  of 
Hippocrates,  and  several  books  of  Galen.  He  enjoyed,  during  his  long 
career,  unalterable  health  and  vigor  of  mind,  which  failed  not  for  an 
instant — rare  and  precious  advantages,  due  to  his  temperance,  purity  of 


290  ERUDITE   PERIOD. 

manners,  and  serenity  of  soul.  He  died  at  the  age  of  ninety-six,  regret- 
ted by  tlie  learned  and  by  the  people. 

Leonicenus  combated  peiscveringly  the  infatuation  of  his  cotem- 
porarics  for  the  Arabs  and  Arabists ;  and  he  had  the  satisfaction  to  see 
them  gradually  return  to  the  study  of  the  Greek  and  Latin  models. 
His  letters  on  the  errors  of  Pliny,  the  naturalist,  and  those  of  some 
other  physicians,  are  written  with  an  elegance  and  purity  unknown 
before  him ;  they  offer  the  first  example  in  this  age  of  an  impartial 
critic  of  the  ancients.  He  demonstrates  that  the  lioman  encyclopedist, 
for  whom  he  testified  otherwise  a  profound  veneration,  fell  into  errors 
and  manifest  contradictions,  for  want  of  understanding  well  the  Greek 
authors  whom  he  compiled,  and  attaches  the  same  reproach,  but  with 
more  severity,  to  the  Arabian  writers.  '•  These  men,"  he  says,  in  speak- 
ing of  the  latter,  '•  never  knew  the  plants  which  they  described ;  they 
obtained  their  description  from  authors  who  had  preceded  them,  and  whom 
they  have  badly  translated.  On  this  account,  there  exists  a  chaos  of 
various  denominations  and  descriptions,  more  and  more  erroneous. 
Unfortunate  the  patient  for  whom  the  physician  should  order  remedies 
on  the  faith  of  Mesne  or  Serapion  !"=■■' 

This  wise  critic  maintained  always  a  tone  of  perfect  urbanity  and 
kindness  against  his  cotemporaries,  whose  scientific  opinions  he  combats. 
Here  is  what  he  wrote  to  Politien,  in  the  letter  we  have  just  cited :  "I 
had  proposed  to  respond,  by  simple  missive,  not  by  a  book,  to  the  rea- 
sons that  j^ou  allcdge  to  justify  Pliny  in  having  confounded  the  ivy  with 
the  rock-rose,  not  being  willing  to  make  public  my  literary  discussions 
with  a  man  who  is  my  intimate  friend,  and  whom  I  honor  from  the  bot- 
tom of  my  heart ;  but  the  matter  requires  more  ample  developments 
than  I  had  sujDposed." 

II.  Thomas  Linacre,  of  Canterbury,  was  the  cotemjiorary  of  Leoni- 
cenus, though  somewhat  younger.  After  having  made  his  first  studies 
at  the  University  of  Oxford,  he  sailed  for  Italy,  in  1484,  for  the  pur- 
pose of  perfecting  his  university  instruction.  He  followed,  at  Florence, 
the  lectures  of  Demetrius  Chalcondylus,  one  of  the  Greek  refugees  of 
whom  I  have  spoken,  where  his  happy  disposition,  joined  to  his  modesty, 
gained  him  the  notice  of  Lorenzo  de  JMedicis.  That  prince  proposed 
to  him  to  become  the  companion  of  his  children  in  their  studies,  whose 
preceptor  was  Angel  Politien,  the  same  to  whom  Leonicenus  addressed 
the  afi'ectionate  expressions  that  we  have  given  above.  The  young  Eng- 
lishman accepted  with  joy  an  ofi'er  so  honorable  to  him,  and  which  gave 
him  an  opportunity  to  satisfy  his  penchant  for  study,  and  he  profited  so 

*  Letter  to  Politier. 


HUMANIST   PHYSICIANS.  291 

well  by  the  lessons  of  his  masters,  that  in  a  short  time  he  became  as 
learned  as  themselves. 

After  being  thus  nurtured  on  the  cream  of  the  finest  literature  of  his 
time,  he  returned  to  his  native  country,  where  his  talents  were  worthily 
appreciated  and  remunerated.  Having  become  physician  in  ordinary  to 
Henry  YII.,  and  the  princess  Mary,  who  afterward  mounted  the  throne 
of  England,  Linacre  showed  himself  worthy  of  his  high  fortune,  by  the 
zeal  he  displayed  all  his  life  in  favor  of  sound  education.  He  was  the 
first  of  his  nation  who  spoke  purely,  the  language  of  the  Eomans.  He 
translated  several  treatises  of  Galen,  and  his  translations  are  still 
esteemed.  These  caused  the  erection  of  two  chairs,  one  at  Oxford,  and 
the  other  at  Cambridge,  the  incumbents  of  which  had  to  explain  the 
works  of  Hippocrates  and  Galen ;  but  what  entitles  him  most  to  the 
gratitude  of  his  countrymen,  is  the  foundation  of  the  College  of  London. 

To  appreciate  properly  the  importance  of  such  a  creation,  and  the 
merit  of  its  author,  we  must  reflect  on  the  circumstances  that  sur- 
rounded this  rising  institution,  and  take  into  consideration  the  obstacles 
that  had  to  be  surmounted.  At  that  epoch,  the  bjshops  alone  had  the 
right  to  give  in  their  dioceses  the  permission  to  practice  medicine, 
whence  it  resulted  that  the  practice  of  the  Healing  Art  was  abandoned 
entirely  into  the  hands  of  monks  and  illiterate  empirics.  Linacre  had 
need  of  all  his  credit  at  court  to  obtain  the  reform  of  such  abuses ;  but 
his  persevering  and  enlightened  zeal  triumphed  over  all  opposition.  He 
obtained  the  issue  of  letters  patent,  which  prohibited  the  practice  of 
Medicine  by  any  one  who  had  not  received  his  degrees  in  one  of  the  two 
universities  in  the  kingdom,  and  who  had  not  been  examined  by  the 
President  of  the  College  at  London,  assisted  by  three  physicians  dele- 
gated especially  for  that  purpose.  Behold  by  what  a  series  of  intelli- 
gent and  generous  eiForts  this  estimable  man  merited  and  obtained  the 
title  of  the  restorer  of  Medicine  in  England.' ■' 

The  two  personages  whose  works  and  influence  on  the  minds  of  their 
compatriots  we  have  just  succinctly  traced,  belong  to  the  commence- 
ment of  the  Erudite  Period.  They  merit  particular  attention,  not  only 
on  account  of  the  importance  of  their  literary  labors,  but  also  because 
they  were  the  first  among  physicians  who  embraced  the  culture  of  the 
Greek  classics,  and  contributed  efl&ciently  to  propagate  it.  Many  others 
afterward  followed  the  same  course,  and  distinguished  themselves  in  the 
same  career,  such  as  Gontier  d'Andernach,  Jac({ucs  Houlier,  Louis 
Buret,  and  others ;  but  I  can  not  enumerate  here  the  titles  of  all  the 
men  of  talent  who  devoted  their  lives  to  restoring  the  monuments  of 

'•"  Hist.  Med.,  by  Freind;   article  Linacre. 


292  ERUDITE   PERIOD. 

ancient  Medicine ;  it  is  sufficient  to  have  signalized  the  general  ten- 
dency of  the  mind  for  bibliographic  researches  at  the  epoch  of  intellec- 
tual regeneration — a  tendency  which  denotes  a  want  profoundly  felt, 
and  which  resulted  from  the  new  direction  their  studies  began  to  take. 

Indeed,  from  the  moment  that  they  began  to  realize  the  superiority  of 
Greek  models  over  their  prolix  Arab  commentators,  they  were  anxious 
to  go  back  to  the  source  of  excellence,  and  sought  with  avidity  the 
originals,  which  had  till  then  remained  covered  up  in  the  rubbish  and 
dust  of  libraries.  But  at  this  time  the  copies  of  Greek  authors  were 
few  in  number,  and  in  a  deplorable  state,  owing  to  the  neglect  they  had 
suffered  during  so  many  ages.  It  then  became  necessary  and  urgent  to 
draw  them  from  obscurity,  to  purify,  co-ordinate,  and  multiply  them, 
especially  by  the  aid  of  printing.  This  work,  too  little  appreciated 
to-day,  required  very  extensive  and  varied  knowledge,  rare  sagacity,  and 
admirable  disinterestedness  and  patience.  The  most  eminent  men  in 
science  did  not  disdain  to  be  thus  occupied.  On  this  account,  the  epi- 
thet, erudite,  seems  to  me  to  be  very  characteristic  of  this  period,  in 
which  the  grammarians  enjoyed  such  great  and  worthy  consideration. 

Among  the  jiublications  in  medical  literature,  belonging  to  this  epoch, 
is  one  which  is  out  of  the  ordinary  line  of  enterprises  of  this  nature, 
and  therefore  merits  special  notice.  I  allude  to  the  complete  edition  of 
the  Hippocratic  writings,  with  a  Latin  translation  of  Anuce  Foes. 
"  In  the  midst  of  the  dearth  of  correct  manuscripts,"  says  a  modern 
historian,*  "  defective  texts,  and  numerous  alterations  introduced  suc- 
cessively by  the  copyists,  an  exact  and  complete  Greek  edition  of  the 
works  of  Hippocrates  was  as  earnestly  desired  as  vainly  expected  for  a 
long  time.  At  last,  the  press  groaned,  and  there  was  seen  issuing  from 
Frankfort  on  the  Main,  in  1595,  a  volume  much  less  frightful  by  its 
mass,  than  by  the  idea  of  the  time,  application,  and  sacrifices  of  ever}"^ 
kind,  that  its  composition  must  have  cost  its  learned  and  laborious 
author."  Foes  was  a  distinguished  practitioner,  whom  fortune  had  not 
much  favored.  He  lived  on  the  product  of  his  business,  and  on  his 
income  as  pensioned  physician  of  the  city  of  Metz.  He  had  consecra- 
ted to  this  immense  work,  the  leisure  and  labors  of  forty  years  of  his 
life.  His  name  is  henceforth  immortal,  by  its  association  with  that  of 
Hippocrates,  as  the  ivy  shares  in  the  strength  of  the  oak  to  which  it 
is  attached. 

I  can  not  pass  in  silence  another  publication  which  dates,  also,  from 
the  last  half  of  the  sixteenth  century,  less  capital  than  the  preceding,  in 
a  medical  point  of  view,  but  in  which  the  author  has  displayed  an 

-'  M.  Dezeimeris. 


ANATOMY   AND   PHYSIOLOGY.  293 

erudition  scarcely  credible ;  it  is  the  treatise  on  the  gymnastics  of  the 
ancients,  by  Jerome  Mercurialis,  a  classic  work,  not  less  precious  to  the 
historian  than  the  antiquarian. 

After  having  thus  rendered  a  just  homage  to  the  bibliographic  labors 
which  concurred  to  the  restoration  of  a  good  taste  in  Europe,  it  is  time 
to  examine,  in  detail,  what  became  of  each  of  tbe  branches  of  medical 
science  during  this  period. 


CHAPTER  II. 

ANATOMY    AND    PHYSIOLOGY. 

About  the  year  1315,  Mondini,  professor  at  Bologna,  dissected  the 
bodies  of  two  women.  Shortly  after,  he  published  an  Epitome  of  Anat- 
omy, illustrated  with  wood  cuts,  which  obtained  general  success,  and 
served  for  more  than  two  centuries,  concurrently  with  the  writings  of 
Gralen  and  the  Arabs,  for  anatomical  demonstrations.  But  this  abridg- 
ment contained  nothing  new :  the  parts  wei-e  indicated  only,  rather  than 
described.  Lauth  expresses  himself  about  this  author,  as  follows : 
*■  Mondini  may  be  considered  an  anatomist  who  has  examined,  with  dis- 
cernment, the  corpses  that  he  has  dissected,  but  we  must  stop  at  splanch- 
nology, if  we  would  not  lose  this  good  opinion.  Let  us  see  how  he 
proceeds  to  reach  the  deep  muscles  of  the  extremities.  '  Beneath  the 
veins  of  the  fore-arm,'  he  remarks,  '  we  see  many  muscles,  and  many  large 
and  strong  cords,  (tendons)  ;  of  which  it  is  not  necessary  to  attempt  the 
anatomy  on  such  a  corpse  (a  recent  one) ,  but  on  one  dried  in  the  sun 
for  three  years,  as  I  have  shown  otherwise,  in  developing  the  number 
and  the  anatomy  of  those  of  the  superior  and  inferior  extremity.'  He 
takes  an  opposite  and  unauatomical  course  to  discover  the  nerves,  advis- 
ing maceration  in  running  water."  ■■=  At  that  era,  and  still  for  a  long 
time  after,  it  was  the  custom  to  demonstrate  anatomy  on  hogs  and  other 
animals,  and  it  was  great  boldness  on  the  part  of  Mondini  to  apply  the 
knife  to  the  human  body.  The  prejudice  against  dissection  of  the 
human  body  was  so  general,  for  more  than  a  century  afterward,  no  one 
dared  renew,  at  least  ostensibly,  the  undertaking  of  the  Bologuesc  pro- 
fessor. His  own  conscience  did  not  seem  to  be  well  satisfied  by  the  ope- 
ration, since  he  was  not  willing  to  open  the  head,  for  fear  of  committing 
a  mortal  sin.     To  comprehend  his  scruples,  and  those  of  his  cotemporaries, 

'"'  Hist,  de  I'Anat.,  Strasbourg,  1815,  t.  I.,  liv.  v,  par.  iv,  sec.  2,  p.  303. 


294  ERUDITE   PERIOD. 

it  will  suffice  to  add  that  Pope  Boniface  VIII.  issued  a  Lull  in  1300, 
which  forbade  the  evisceration  and  anatomical  cooking  preparation  of 
the  dead.  This  prohibition,  it  is  true,  says  Holfinx,  Avas  only  designed 
to  abolish  the  absurd  custom  introduced  by  the  crusaders,  of  cutting 
up  and  boiling  the  bodies  of  their  relatives,  deceased  in  infidel  countries, 
so  as  to  send  them  to  their  families  to  give  them  a  burial  in  holy  ground ; 
but  it  is  certain  that  the  same  bull  was  interpreted,  whether  right  or 
wrong,  as  prohibiting  anatomical  dissection,  for,  in  1482,  the  university 
of  Tubingen  had  recourse  to  the  authority  of  Pope  Sixtus  IV.  to  obtain 
permission  for  dissection. ••= 

It  was  only  toward  the  close  of  the  fifteenth  century,  and  in  the  early 
years  of  the  sixteenth,  that  this  prejudice  began  to  abate.  The  popes 
themselves,  who  stood  then  at  the  head  of  scientific  movements,  with- 
drew their  interdictions,  and  the  universities  of  Italy  gave  the  first  ex- 
amples of  public  dissections.  Achillini,  Benedetti,  and,  perhaps  also, 
Jacques  Berenger,  dissected  previously  to  the  year  1500,  at  Bologna,  Pa- 
dua, and  Pavia.  Soon  after,  their  example  was  followed  in  many  other 
places.  Toward  the  close  of  the  sixteenth  century,  Dubois,  called  Syl- 
vius, following  the  fashion  of  the  times,  demonstrated  anatomy  at  Paris, 
on  the  dead  body.  He  gave  for  forty  years,  vei-y  frequently,  special 
courses,  and  contributed  very  much  to  popularize  the  taste  for  this 
science.  He  dissected  a  great  number  of  animals,  and  as  many  dead 
bodies  as  he  could  procure,  which  was  no  easy  matter  at  that  time,  as 
we  shall  presently  sec.  He  subordinated,  however,  all  his  researches 
to  the  authority  of  Galen :  so  much  so,  that  he  would  not  admit  any 
remark  contrary  to  the  statements  of  this  author,  unless  that  which 
contradicted  him  was  considered  as  a  freak  of  nature,  or  a  result  of  the 
degeneration  of  the  human  species. 

In  like  manner,  all  the  other  anatomists  followed  this  vicious  course ; 
no  one  would  permit  himself  to  contradict  the  assertions  of  the  oracle 
of  Pergamos ;  until,  at  last,  a  man  of  genius  and  courage,  prepared  for 
literary  discussion  by  severe  study — a  true  reformer — appeared.  He  was 
Andrew  Vesalius.  Born  at  Brussels,  in  1514,  of  a  family  for  a  long 
period  illustrious  in  ]\[edicine,  he  studied  the  humanities  at  Louvain. 
under  Guinther,  or  Gonthier  d'Andernach,  who  was  there  professor  of 
the  Greek  language.  Already  the  inclination  of  the  young  scholar,  for 
anatomy,  revealed  itself  in  his  pastimes ;  he  amused  himself  in  dis- 
secting, during  the  recreations,  rats,  moles,  dogs,  etc.  He  made  a  con- 
quest, literally,  of  his  first  skeleton,  on  the  place  of  execution  near 
Louvain.     Having  observed  the  body  of  a  criminal,  of  which  the  birds 

=^Hist.  de  I'Anat.,  t.  I.,  lib.  v,  part  iv,  sect.  2,  p.  303. 


ANATOMY   AND   PHYSIOLOGY.  295 

had  so  perfectly  cleaned  away  the  soft  parts,  that  there  remained  of  it 
only  the  bones  and  ligaments,  he  detached  successively  the  extremities ; 
but  when  he  attempted  to  carry  off  the  trunk,  he  found  it  so  strongly 
bound  to  the  stake  by  the  iron  chains,  that  he  was  comjjelled  to  work 
all  night  to  get  it  loose. 

Afterward,  he  went  to  Paris,  attracted  by  the  course  of  Sylvius,  which, 
as  we  have  remarked,  had  acquired  great  reputation.  While  there,  he 
was  not  content  with  the  lessons  of  his  master,  but  wished  to  observe 
nature  himself;  to  accomplish  which  he  had,  more  than  once,  to  dispute 
with  the  dogs  and  vultures  at  the  hill  of  Montfaucon,  for  the  remains  of 
criminals,  or  to  introduce  himself  stealthily  into  the  cemeteries,  to  dis- 
inter a  body,  at  the  risk  of  incurring  the  accusation  of  the  capital  crime  of 
sacrilege.  His  progress  was  as  rapid  as  his  ardor,  for  his  application  was 
great.  From  his  twentieth  year,  he  gave  instructions  at  Paris,  to  his 
fellow  students,  and  exhibited  to  them  the  semi-lunar  valves  of  the 
aorta,  which  Sylvius  had  not  found.  At  the  age  of  twent^'-three,  he 
was  nominated  to  the  chair  of  anatomy  in  the  faculty  at  Padua,  by  the 
senate  of  Venice  ;  at  twenty-nine,  he  published  his  great  work,  in  which 
this  science  is  placed  in  a  new  light,  and  with  a  completeness  which  left 
far  in  the  rear  all  that  antiquity  had  transmitted  on  the  subject.  ■'  The 
year  following,  Yesalius,  no  less  renowned  as  a  practitioner  than  as  an 
anatomist,  was  called  by  the  Emperor  Charles  V..  to  the  court  of  Mad- 
rid, then  the  most  brilliant  in  Europe,  in  the  character  of  first  physi- 
cian. From  this  time  he  abandoned  his  anatomical  labors,  to  resume 
them  no  more. 

Vesalius  dared  subordinate  the  authority  of  Galen  to  anatomical  in- 
spection. He  refuted  many  errors  in  his  anatomy,  and  asserted  that 
the  greater  part  of  his  descriptions,  having  been  made  from  monkeys, 
did  not  correctly  represent  the  human  structure.  This  audacity  raised 
up  against  him  numerous  opponents,  among  whom  his  old  master,  Syl- 
vius, showed  himself  the  most  animated  and  the  least  reasonable  ;  but 
the  young  reformer  vigorously  made  head  against  the  storm,  and  as 
truth  was  on  his  side,  at  last  triumphed.  He  was  not,  however,  him- 
self free  from  censure,  notwithstanding  the  multiplied  dissections  which 
had  served  as  the  basis  of  his  anatomy.  He  was  amenable  to  the  reproach 
brought  against  him  by  Columbus  and  Eustachius,  that  his  descriptions 
of  the  eyes,  muscles  of  the  larynx,  and  tongue  are  not  in  accordance 
with  nature.  But,  as  said  Lauth  on  this  subject,  "  these  iri-egularities 
and  defects  in  his  work  do  not  destroy  his  glory  ;  there  results  from  it, 

'^De  Humani  Corporis  Fabrica,  libri  septem.,  Basle,  1843,  with  wood  cuts. 


296  ERUDITE   PERIOD. 

simply,  that  the  route  which  he  had  traced  was  the  true  one,  and  wae 
still  open  to  conduct  other  learned  investigators  to  celebrity.  "■■■= 

The  minds  of  men  generally,  were  ripe  for  the  revolution  of  which 
Vesalius  gave  the  signal ;  what  proves  it  is,  that  scarcely  had  he 
appealed  from  the  decision  of  Galen  to  the  observations  of  nature,  than 
a  crowd  of  anatomists  struggled  to  follow  his  method.  We  have  already 
cited  Columbus,  who  was  his  pupil — his  co-laborer,  and  successor  to  the 
chair  in  Padua;  B.  Eustachius,  professor  at  Eome,  who  shared  with 
Vesalius  the  honor  of  having  founded  human  anatomy,  and  of  having 
made  astonishing  progress  in  it.  We  place  on  the  same  line,  Fallopius, 
disciple  and  friend  of  Vesalius,  who  was  professor,  successively,  at 
Ferrara,  Pisa  and  Padua.  He  died  prematurely  for  the  science  which 
he  had  cultivated  with  so  much  ardor  and  success  ;  and  his  name  must 
rest  united  to  that  of  Vesalius  in  the  history  of  modern  anatomy,  as 
those  of  Herophilus  and  Erasistratus  are  in  the  history  of  ancient 
anatomy.  Lauth  gives  the  following  opinion  of  bis  labors :  ' '  Fallopius  is  as 
much  distinguished  for  the  delicacy  of  his  language  as  for  his  anatomical 
talents.  Under  the  modest  title  of  "  Observations,"  he  has  published  a 
treasury  of  discoveries  on  all  parts  of  the  human  structure ;  and  when 
he  sees  himself  obliged  to  correct  Vesalius,  he  always  softens  the  style  of 
his  criticism,  though  he  does  not  abate  its  depth ;  so  that  the  work  of 
Fallopius  is  an  excellent  commentary  on  that  of  Vesalius." 

The  researches  of  Jerome  Fabricius.  on  the  formation  of  the  egg 
and  of  the  fetus — on  the  valves  of  the  veins  and  the  viscera,  have 
equally  a  capital  importance.  They  were  designed  for  a  treatise  on 
human  and  comparative  anatomy,  which  the  author  had  not  time  to 
complete.  But  here  I  feel  that  I  must  pause  ;  very  many  other  names, 
and  many  other  works,  have  a  right  to  be  mentioned,  but  I  am  forced  to 
pass  them  in  silence,  and  refer  the  reader  to  the  special  histories  of 
Anatomy  for  them. 

At  this  epoch,  many  modifications  were  introduced  in  the  regulation*- 
of  the  Faculties  of  Medicine  ;  permanent  amphitheaters  for  dissection 
began  to  be  established — for  till  then,  the  anatomists  had  dissected 
either  in  their  chambers  or  in  some  provisional  hall.  Anatomical 
chairs  were  created,  and  the  salaries  paid  out  of  the  public  treasury.  In 
some  cities  the  supply  of  material  was  not  limited  to  the  bodies  of  crim- 
inals, but  permission  was  also  given  to  dissect  the  dead  at  the  hospitals. 
The  Koman  Pontiifs  seem  to  have  taken  the  initiative  in  this  respect, 
which  explains  the  great  number  of  subjects  with  which  Eustachius  was 
supplied,  compared  with  Vesalius,  who  obtained  only  two  or  three  in  a 

*»  Hist,  de  I'Anat.,  p.  373. 


ANATOMY   AND   PHYSIOLOGY.  297 

year.  The  razor,  a  very  incommodious  instrument,  was  also  replaced  in 
dissection  by  the  pointed  scalpel,  which  has  remained  in  use  till  now. 

This  concourse  of  circumstances  elevatsd  anatomy  very  promptly,  to 
a  degree  of  psrfection  it  had  never  attained  under  the  Greeks.  Plates, 
designed  by  skillful  artists  after  very  careful  anatomical  preparations, 
represented  our  organs  with  more  exactness  and  detail  than  had  been 
supposed  possible.  The  nerves  were  entirely  separated  from  the  tendons 
and  ligaments.  They  were  traced  as  far  as  possible,  from  their  origin 
to  their  finest  ramifications:  and  the  anatomists  assured  themselves  that 
the  muscular  fibre  was  not  produced  by  an  expansion  of  the  nervous 
fiber.     A  glimpse  was  also  obtained  of  the  lymphatic  vessels. 

Capital  discoveries  were  also  made  in  the  vascular  apparatus.  It 
was  discovered  that  there  was  no  bony  structure  in  the  tissue  of  the 
heart,  as  the  ancients  believed  ;  that  the  partition  which  separates  the 
cavities  of  that  viscus,  was  not  at  all  porous,  so  that  the  blood  could  not 
pass  from  one  cavity  to  another,  through  the  septum.  The  attentive 
examination  of  the  valves  led,  finally,  to  the  discovery  of  the  pulmonary 
circulation.  Michael  Servetus,  the  same  whom  Calvin  burned  at  the 
stake,  was  the  first  to  discover  this  important  phenomenon.  He  saw  that 
the  sanguinary  fluid  could  not  penetrate,  directly,  the  left,  from  the  right 
cavities  of  the  heart,  owing  to  the  impermeability  of  the  partition,  so  that 
it  was  necessary  for  the  whole  mass  of  the  liquid  to  pass  through  the  lung, 
where  it  became  impregnated  with  the  vital  spirit  contained  in  the  atmos- 
phere, and  reached,  afterward,  the  left  auricle.  The  disposition  of  the 
valves  of  the  pulmonary  artery  and  veins,  plainly  confirmed  this  conjec- 
ture. Besides,  the  caliber  of  the  pulmonary  artery  appeared  enor- 
mously disproportioned  to  the  quantity  of  blood  necessary  for  the 
nutrition  of  the  lungs ;  which  seemed  to  prove  that  such  was  not,  as  had 
been  believed  true  till  then,  the  unique  purpose  of  that  vessel.  About  the 
same  period  Fabricius  d"Aquapendente,  pointed  out  the  valves  in  the 
veins  of  various  parts  of  the  body :  and  shortly  after,  Columbus  and 
Andrew  Cesalpine  explained  in  a  more  explicit  manner  the  mechanism 
of  the  pulmonary  circulation. 

All  these  discoveries  were  an  immense  progress  made  toward  the  dis- 
covery of  the  great  circulation.  It  seemed  that  there  remained  only  a 
small  step,  to  arrive  at  it ;  and  we  feel  astonished  that  those  great 
anatomists  of  the  sixteenth  century  should  have  paused  in  so  plain  a 
path.  Andrew  Cesalpine  so  closely  approached  this  conception  that 
some  have  thought  that  he  attained  it ;  but  the  passage  on  which  they 
sustain  themselves  does  not  authorise  that  opinion.  The  following  is 
his  statement:  "  The  openings  of  the  heart  are  disposed  in  such  a  man- 
ner that  the  passage  is  free  from  the  vena  cava  into  the  right  ventricle 
19 


298  ERUDITE   PERIOD. 

and  from  that  cavity  into  the  lung ;  further,  there  exists  a  communica- 
tion from  the  lung  to  the  left  ventricle,  and  from  this  last  into  the 
aorta.  Membranes  are  placed  at  the  orifices  of  the  various  conduits,  in 
such  a  way  that  a  retrogade  flux  of  the  liquid  column  is  impossible.  In 
this  way  is  effected,  continually,  the  passage  of  the  blood  from  the  vena 
cava  into  the  right  cavities  of  the  heart,  and  from  these  into  the  lungs, 
and  thence  into  the  aorta  by  the  intermediation  of  the  left  ventricle,  as 
we  have  explained  in  the  Peripitecian  questions.  Now  while  awake, 
the  movement  of  the  innate  heat  is  from  within  outward,  and  during 
sleep  it  is  the  reverse ;  hence  it  follows,  that  while  awake  a  great 
quantity  of  the  vital  spirit  and  blood  are  carried  to  the  arteries,  which 
transmit  them  to  the  nerves ;  and,  during  sleep,  the  same  heat  returns 
to  the  heart,  not  by  the  arteries,  but  by  the  vena  cava,  which  alone  com- 
municates with  this  organ. 

"  The  proof  of  this  is  drawn  from  the  arterial  pulsations,  which  are 
large,  vehement,  prompt  and  frequent,  with  a  species  of  vibration  at  the 
moment  of  awaking,  while  they  are  small,  languishing  and  slow  during 
sleep — for  at  this  time  the  natural  heat  is  carried  less  to  the  arteries : 
but  it  flows  freely  there,  as  soon  as  we  are  aroused. 

"  The  veins  act  entirely  different ;  they  enlarge  during  sleep,  and 
diminish  when  we  are  awake,  which  is  easily  seen  in  those  on  the 
hands.  This  occurs,  because  during  sleep  the  natural  heat  passes  from 
the  arteries  into  the  veins,  by  means  of  their  anastomases,  and  in  that 
way  returns  to  the  heart.  In  the  same  manner  the  flux  and  reflux  of 
the  blood  toward  the  superior  and  inferior  parts,  like  the  waves  of  Eu- 
ripus,  manifest  themselves  during  sleep,  and  when  we  are  awake  also. 
The  same  species  of  movement  is  manifested  either  by  applying  a  liga- 
ture around  some  part  of  the  body,  or  by  pressure  on  the  veins  in  any 
other  way.  For  when  the  course  of  a  stream  is  interrupted,  it  swells 
above  the  obstacle.  Perhaps  in  this  case  the  blood  returns  back  to  its 
source  (son  principe),  so  that  this  interruption  may  not  (ne  Veteigne) 
destroy  it."" 

*  This  passage  is  of  extreme  importance,  because  upon  it  is  founded  the  right 
of  Cesalpine  to  the  greatest  discovery  of  modern  physiology.  I  have,  therefore, 
thought  it  proper  to  transcribe  here  the  text,  even,  of  the  author,  so  that  each  one 
may  judge  for  himself,  having  the  passage  in  his  hands  : 

"  Ilud  sciendum  est :  cordis  meatus  ita  a  natura  paratos  esse,  ut  ex  vend  cava 
intromissio  hat  in  cordis  ventriculum  dextrum,  unde  patet  exitus  in  pulmo- 
nem:  ex  pulmone  prretereli  alium  ingressum  esse  in  cordis  ventriculum  sinis- 
trum,  ex  quo  tandem  patet  exitus  in  arteriam  aortam,  membranis  quibusdam  ad 
ostia  vasorum  appositis,  ut  impediant  retrocessum :  sic  enim  perpetuus  quidam 
motus  ex  vena  cava  per  cor  et  pulmones  in  arteriam  aortam,  ut  in  qunestionibus 
peripateticis  explicavimus.     Ciim  autem  in  vigilia  motus  caloris  nativi  fiat  extra, 


HYGIENE.  299 

Observe  first,  that  this  passage  includes  all  the  elements  necessary  to 
arrive  at  the  knowledge  of  the  circulation  of  the  blood.  The  author 
says,  positively,  that  the  blood  cannot  flow  backward,  through  the  arte- 
ries, toward  the  heart,  on  account  of  the  membranes  which  close  the 
orifice  of  the  aorta ;  and  he  adds  that  the  vena  cava  is  the  only  vessel 
which  permits  its  entrance  into  that  viscus.  He  speaks,  also,  of  the 
anastamoses  of  the  arteries  and  veins.  He  remarks,  that  if  a  band  is 
applied  around  a  member,  the  veins  tumefy  below  the  ligature.  Does  it 
not  seem  that  the  author  needed  only  to  pronounce  the  word  circulation, 
to  have  resolved  the  problem  ?  But  this  word  fell  not  once  from  his 
pen ;  but  he  compares  it  to  the  flux  and  reflux  of  Euripus,  as  Aristotle 
had  done.  It  is  evident  that  he  tortured  his  mind  to  conciliate  two 
irreconcilable  theories,  viz.:  the  opinions  of  the  ancients  on  the  move- 
ment of  the  blood,  with  the  recent  discoveries  of  anatomy.  Thus,  the 
glory  of  Harvey  is  untouched  by  this  discussion,  as  will  appear  more 
evident  still,  in  its  place. 


CHAPTER   III. 
HYGIENE. 


Next  to  anatomy,  hygiene  was  one  of  the  branches  of  Medicine  least 
cultivated  in  the  middle  ages.  The  governments  being  entirely  occu- 
pied with  the  care  of  maintaining  and  extending  their  dominions,  never, 


scilicet  ad  sensoria :  in  somno  autem  intra,  scilicet  ad  cor :  putandum  est  in 
vigilia  multum  spiritiis  et  sanguinis  ferri  ad  arterias,  inde  enini  in  nervos  est 
iter.  In  somno  autem  eumdem  calorem  revcrti  ad  cor,  non  per  arterias:  ingres- 
sus  enim  naturalis  per  venam  cavam  datur  in  cor,  non  per  arteriam.  Indicio 
sunt  pulsus,  qui  expergiscentibus  fiunt  magni,  veliementes,  celereres  et  crebri 
cum  quadam  vibratione:  in  somno  autem  parvi,  languidi,  tardi  et  rari  (3  De 
cans,  pul.,  2  &t  \0) .  Nam  in  somno  calor  nativs  minus  vergit  in  artei-ias:  in 
easdem  erumpit  veliementiiis,  cum  expergiscuntur. 

"  Venae  autem  contrario  se  modo  habent :  nam  in  somno  fiunt  tumidiores  in 
vigilia  exiliores,  ut  patet  intuenti  eas  quce  in  manu  sunt.  Transit  enim  in 
somno  calor  nativus  ex  arteriis  in  venas  per  osculorum  communionem,  quam  anas- 
tomosin  vocant,  et  inde  in  cor.  Ut  autem  sanguinis  exundatio  in  superiora,  et 
retrocessus  in  inferioria,  instar  Euripi,  manifesta  est  in  somno  et  vigilia,  sic  non 
obscurus  est  bujusmodi  motus,  in  quacumque  parte  corporis  vinculum  adhibear 
tur,  aut  alia  ratione  occludantur  vena;.  Cum  enim  tollitur  permeatio,  intu- 
mescunt  rivuli  qua  parte  fluere  solent.  Forte  recurrit  eo  tempore  sanguis  ad 
principium,  ne  intercisus  extinguatur."  (Andreae  Cassalpini,  Quaefdonum  medica- 
rum,  lib.  (8c.')  qusestio  xvii.     Venetiis,  apud  Juntas,  1571. 


300  ERUDITE   PERIOD. 

or  very  rarely,  inquired  into  what  concerned  public  health.  In  the  capi- 
tals even  of  European  states,  no  measure  of  police,  no  administrative 
rule,  existed  for  keeping  the  streets  and  houses  clean,  the  free  circula- 
tion of  air,  the  soundness  of  the  food  employed  by  the  people,  and  the 
propagation  of  hygienic  habits.  Those  who  founded  or  endowed  hospi- 
tals, asylums,  and  monasteries  were  not  moved  by  any  thoughts  of  social 
amelioration,  but  by  a  pure  sentiment  of  Christian  charity — or  the  fear 
of  hell.  In  the  establishments  for  public  instruction,  nothing  was  fore- 
seen or  ordered,  in  view  of  the  physical  perfection  of  man ;  none  but 
the  most  ordinary  and  urgent  cares  were  bestowed  upon  the  health  of 
the  pupils.  There  was,  moreover,  an  opinion  universally  diffused,  and 
received  almost  as  an  article  of  faith,  that  there  was  no  better  means 
for  increasing  the  intelligence  and  enlarging  the  empire  of  the  soul, 
than  to  mortify  the  body.  The  statutes  of  most  of  the  religious  orders 
had  no  other  object.  The  clergy,  placed  at  the  head  of  instruction  and 
of  the  liberal  professions,  were  profoundly  imbued  with  this  prejudice, 
which  explains  their  indifference  to  the  physical  education  of  youth. 
During  the  lapse  of  several  ages,  no  other  hygienic  code  was  in  vogue 
than  the  dietetic  maxims  of  the  school  of  Salerno,  in  which  there  was 
nothing  to  justify  its  high  reputation." 

On  the  revival  of  letters,  the  attention  of  physicians  was  early  turned 
toward  the  means  of  preserving  health  and  preventing  diseases.  But. 
at  first,  they  only  compiled,  with  more  or  less  erudition,  the  teachings 
of  the  ancients  on  this  matter.  The  earliest  writings,  at  all  original  on 
this  subject,  belong  to  the  second  half  of  the  sixteenth  century,  and 
appertain  to  a  man  unconnected  with  Medicine. 

Louis  Cornaro,  a  Venetian  noble,  had  never  enjoyed  robust  health,  and 
at  the  age  of  thirty-five  he  saw  that  his  health  was  growing  worse.  He 
was  a  prey  to  pains  in  the  stomach,  with  loss  of  appetite,  and  attacks 

'  My  manuscript  was  finished,  and  already  in  the  hands  of  the  printer,  when 
I  saw  the  work  of  iM.  Levj,  in  which  I  find  a  just  and  elevated  appreciation  of 
the  Saleruian  Sentences.  I  think  I  can  not  do  better  than  copy  them  for  the 
reader  :  "  If  we  place  ourselves  in  the  perspective  of  the  progress  accomplished 
during  the  last  four  or  five  hundred  years,  to  judge  of  this  book,  which  is  a  sum- 
mary of  the  spirit  of  that  celebrated  school,  we  perceive  only  an  undigested 
mass  of  Medicine  and  dietetics :  a  fragment  of  Galenism,  united  to  the  recipes 
of  the  Arabian  polypharmacy ;  the  maxims  of  antique  wisdom,  and  the  accred- 
ited echoes  of  the  popular  superstitions.  But  let  us  not  judge  the  works  of  past 
centuries  by  the  light  of  our  day.  The  Medical  Testament  of  Salerno  is  a  his- 
torical document,  and  not  a  work  to  study,  in  regard  to  the  present  state  of 
science.  Nevertheless,  we  find,  on  several  of  its  pages,  distinct  reflections  of  the 
Hellenic  school,  and  more  than  one  sound  hygienic  maxim  strikes  us  as  being  of 
Hippocratic  origin." 


HYGIENE.  301 

of  gout  more  and  more  frequent.  Besides,  he  felt  himself  slowly  con- 
sumed by  a  slight  continued  fever,  and  was  a  prey  to  a  thirst  which  he 
could  not  satisfy.  For  five  consecutive  years,  he  employed  all  sorts  of 
remedies  without  obtaining  any  relief;  on  the  contrary,  his  condition 
became  worse  every  day,  and  he  saw  in  prospect  only  an  untimely  death, 
preceded  by  long  sufferings.  Finally,  his  physicians  told  him  that  there 
was  only  one  re.-^ource  left,  and  that  was,  to  renounce  his  habits  of  in- 
temperance, and  adopt  a  course  of  life  extremely  sober,  from  which  he 
must  never  vary.  Cornaro  took  a  firm  resolution,  and  held  it.  In  the 
first  place,  he  studied  to  know  the  various  species  of  aliment  which 
suited  his  stomach,  and  the  quantity  to  take,  in  order  not  to  be  incom- 
moded. After  some  experiments,  he  fixed  on  twelve  ounces  of  solid 
food,  composed  of  bread,  yolk  of  eggs,  meat,  fish,  etc.,  and  fourteen 
ounces  of  liquid.  Every  morning,  he  weighed  out  his  rations  for  the 
day.  This  regimen  suited  him  so  well  that,  at  the  end  of  a  year,  he 
was  freed  from  all  his  afflictions.  At  the  same  time,  his  appetite 
returned:  he  recovered  his  former  gaiety,  equanimity  of  humor,  apti- 
tude for  mental  efforts,  and  bodily  exercises.  In  short,  he  lived  without 
infirmities  to  the  age  of  one  hundred  years. 

The  whole  life  of  Cornaro  oBFers  us  a  striking  example  of  the  salutary 
effects  of  sobriety;  but  there  is  one  trait  in  it  which  shows  the  power 
of  habit.  At  the  age  of  seventy-eight,  overcome  by  the  solicitations  of 
his  friends  and  kinsfolk,  who  pressed  him  to  relax  a  little  the  severity 
of  his  diet,  he  consented  to  add  to  it,  two  ounces  of  solids,  and  two  of 
liquids,  each  day.  His  stomach  was  very  soon  deranged ;  he  lost, 
gradually,  his  appetite,  and  his  manner  became  taciturn ;  in  fine,  he 
soon  fell  into  a  severe  fever,  which  lasted  thirty  days  and  nearly  de- 
stroyed him.  He  was  not  re-established  until  he  had  resumed  his 
former  way  of  living.  In  his  account  of  the  advantages  of  sobriety, 
Cornaro  takes  pleasure  in  enumerating  all  the  happy  effects  which  he 
realized  from  his  manner  of  living.  He  states,  that  he  composed,  in  his 
eightieth  year,  a  comedy,  characterized  hy  refined  and  pointed  wit,  and 
written  in  a  lively  style.  At  this  age,  he  mounted  his  horse  easily,  and 
climbed  the  steepest  hills,  and  was  always  in  a  good  humor.  In  his  old 
age,  nevertheless,  he  endured  some  severe  trials ;  but  he  overcame  them 
well,  thanks  to  the  happy  disposition  of  mind  and  body  with  which  his 
regimen  endowed  him.  On  one  occasion,  among  others,  he  was  obliged 
to  sustain  a  severe  law-suit,  which  caused  the  death  of  his  brother  from 
chagrin ;  but,  though  the  suit  concerned  himself  especially,  his  health 
was  not  altered  nor  his  courage  shaken,  and  he  came  out  of  it  victo- 
rious in  every  respect.  Nevertheless,  the  enthusiasm  of  the  old  man 
did  not  go  so  far  as  to  believe  that  the  same  diet  would  suit  everybody : 


302  ERUDITE   PERIOD. 

he  only  asserted  that  if  men  never  went  beyond  the  limit  of  need,  in 
eating  and  drinking,  they  would  avoid  a  great  many  infirmities,  and  pro- 
long  their  days  much  beyond  the  period  usually  attained.'-'-' 

The  history  of  Cornaro,  say  Halle  and  Nysten,  may  be  placed  with 
the  number  of  fine  experiments  which  have  been  made  in  hygiene ;  and, 
consetj^uently,  which  have  contributed  to  fix  its  principles,  and  concur  to 
the  progress  of  the  art.f 

I  shall  say  nothing  of  the  memoir  of  the  Jesuit  Lessius,  on  the  same 
subject,  because  it  is  only  a  paraphrase  of  the  treatise  of  Cornaro  ;  but 
I  must  mention  here  the  treatise,  on  Gymnastics,  by  Mercurialis.  This 
work,  whose  literary  merit  I  have  already  appreciated,  does  not  develop 
any  new  notion,  it  is  true,  but  directs  the  attention  of  men  of  the  Pro- 
fession, and  the  public  at  large,  to  hygienic  considerations,  so  long  aban- 
doned and  forgotten.  It  must,  therefore,  contribute  to  the  restoration 
of  hygiene. 


CHAPTER    IV. 

GENERAL    PATHOLOGY. 

We  now  return  to  the  ancient  divisions  of  Medical  science,  such  as 
Galen  and  Celsus  adopted :  that  is  to  say,  that  after  having  studied  man 
in  the  normal  state,  in  anatomy,  physiology,  and  hygiene,  we  proceed  to 
study  him  in  the  abnormal  state,  in  pathology  and  therapeutics.  These 
last  two  departments  will  be  divided,  as  heretofore,  into  internal  and 
external.  However  irregular  may  appear  this  distribution  of  diseases, 
we  are  forced  to  follow  it,  because  it  was  adopted  by  all  the  authors  of 
that  period.  Pathology  is  a  subject  so  vast,  so  complex,  and  so  change- 
able, that  it  is  impossible  to  establish  an  irreproachable  classification  ; 
we  must,  therefore,  content  ourselves  with  an  exactness  more  or  less 
approximative.  But  let  it  be  remembered,  that  a  classification  even 
vicious,  is  much  better  than  none  at  all,  for  this  latter  state  is  nothing 
less  than  chaos — the  negation  of  all  general  ideas,  of  all  science.  The 
distinction  of  diseases  into  acute  and  chronic,  existed  then  as  at  pres- 
ent ;  but  in  their  treatises,  no  separation  was  made  of  the  first  from  the 
second,  as  the  ancient  Methodists  had  done ;  the  acute  and  chronic 
states  were  considered  as  two  forms  of  the  same  morbid  entity,  not  as 

''  On  Sobriety  and  its  Advantages,  by  Lessius  and  Cornaro ;  new  translation, 
by  M.  de  la  Bonardiere,  Paris,  1701. 
f  Dictionaire  des  Sciences  Medicales,  in  sixty  vols.;  art..  Hygiene. 


INTERNAL   PATHOLOGY.  303 

two  different  species.  Etiology  was  treated  with  much  more  subtiltj, 
in  conformity  with  the  Peripitecian  doctrine,  as  we  shall  show  in  the 
chapter  on  theories.  In  short,  we  see  commenced  in  this  period  the 
rudiments  of  a  new  branch  of  pathology,  which  is  styled  pathological 
anatomy,  and  which  is  destined  to  acquire  a  capital  importance  in  mod- 
ern times. 


CHAPTEE    V. 
INTERNAL    PATHOLOGY. 

§  I.  Semeiotics. 

The  section  of  pathology  which  is  devoted  to  the  interpretation  of 
symptoms,  considered  in  a  general  and  abstract  manner,  made  but  few 
acquisitions  after  Gralen.  The  Arabs  added  to  the  science  only  a  small 
number  of  observations,  the  most  interesting  of  which  belong  to  erup- 
tive fevers ;  and  the  Greeks  and  Latins  of  the  middle  ages  did  little 
more  than  copy  each  other.  At  the  epoch  of  the  revival  of  letters, 
writers  occupied  themselves  in  collecting  the  discoveries  of  anterior  ages, 
to  withdraw  them  from  the  oblivion  into  which  most  of  them  had  fallen, 
to  elucidate  and  put  them  in  order.  They  made,  to  use  the  expression 
of  Guy  de  Chauliac,  an  inventory  of  all  the  acquisitions  of  the  past,  and 
this  was  the  best  which  at  that  time  could  be  done ;  for,  before  inno- 
vating and  reforming,  it  is  necessary  to  know  what  exists,  and  to  be 
acquainted  with  the  actual  state  of  science. 

The  savans  of  the  fifteenth  and  sixteenth  centuries  acquitted  them- 
selves perfectly  of  this  task,  as  we  have  already  shown.  If  they  did 
not  make  many  discoveries,  they  prepared  the  way  for  their  successors, 
for  the  rejuvenation  of  ancient  ideas  so  long  forgotten.  Can  not  this, 
to  some  extent,  be  called  an  invention  ?  Among  those  whose  writings 
contributed  to  elucidate  semeiotics,  may  be  cited  Vallesius,  Prosper 
Alpin,  Lommius,  Thomas  Fyens,  and  especially,  J.  Fernel.  The  latter 
offers  us,  in  the  second  and  third  books  of  his  pathology,  the  most  suc- 
cinct and  lucid  summary  of  the  notions  and  ideas  that  composed  the 
science  of  symptoms  among  the  ancients.  After  having  defined  what 
he  understands  by  signs  and  by  symptoms,  and  how  these  phenomena 
must  be  distinguished  from  the  disease  itself,  he  exposes  the  signs  of 
various  species  of  plethora,  namely,  the  sanguineous,  bilious,  melan- 
cholic, pituitous,  and  serous ;  then  he  devotes  the  whole  of  the  third 
volume  to  an  examination  of  the  pulse  and  the  urine.  In  this  we  find 
sphygmology  and  uriscopy  forming  the  basis  of  prognosis  and  of  curative 


304  ERUDITE   PERIOD. 

indications ;  further,  that  they  did  not  hold  to  the  plan  of  grouping 
symptoms  to  form  tableaux,  according  to  the  synthetic  method,  of  which 
Hippocrates  has  given  so  fine  an  example  in  his  treatise  on  Prognosis, 
but  that  a  separate  examination  was  made  of  each  phenomenon,  which 
was  isolated,  and  an  eflFort  made  to  go  back  to  its  cause,  so  as  to  deduce 
all  the  indications  it  could  furnish,  according  to  the  analytic  method 
introduced  by  Aristotle  and  continued  by  Galen. 

"  The  pulse  and  the  urine,"  remarks  Fernel,  "  furnish  the  surest  indi- 
cations concerning  the  force  of  diseases ;  the  first,  by  i-evealing 
the  state  of  the  heart  and  the  arteries ;  the  second,  by  indicating  the 
state  of  the  liver  and  the  veins ;  for  these  organs  hold  under  their 
dominion  the  whole  economy.  The  pulse  shows  clearly  the  energy  pos- 
sessed by  the  vital  faculty,  as  well  as  the  whole  body,  and  shows  the 
present  condition  of  the  heart  and  arteries.  The  urine  reveals  the 
qualities  of  the  humors  and  the  state  of  the  liver  in  a  very  ( istinct 
manner,  it  enlightens  us  on  the  diseases  derived  from  them,  but  it  fur- 
nishes but  little  light  as  to  the  vigor  of  the  vital  movements,  and  of  the 
body  in  general.  "=•■=  The  whole  of  the  third  book  is  only  the  develop- 
ment of  the  proposition  just  quoted,  namely,  the  theory  of  the  pulse 
and  the  urine. 


§  n.     Pathological  Anatomy. 

Toward  the  end  of  the  Erudite  Period,  pathology  was  enriched  from  a 
new  source,  and  one  destined  to  shed  great  light  on  the  dijjgnosis  of  dis- 
eases, and  which  establishes  a  line  of  demarcation  between  ancient  and 
modern  Medicine  ;  this  is  pathological  anatomy.  The  idea  of  studying 
the  sensible  traces  that  disease  leaves  in  our  organs  after  death,  began  to 
germinate  in  the  minds  of  physicians  at  the  close  of  the  fifteenth  century. 
Anthony  Benivieni,  a  physician  of  Florence,  appears  to  have  been  the  first, 
or  at  least  one  among  the  first,  who  conceived  of  the  knowledge  that  might 
be  attained  by  opening  bodies  with  the  view  of  ascertaining  the  location  and 
causes  of  diseases.  M.  Malgaigne remarks  as  follows  about  this  author: 
"  A  eulogy  which  he  merits  without  reserve,  which  he  shares  with  no  other 
person,  and  which  has  not  been  accorded  to  him,  up  to  this  time,  by 
the  many  historians  of  surgery  who  have  superficially  searched  in  these 
precious  sources,  is,  that  he  was  the  first  who  had  the  habit,  and  felt 
the  need,  and  set  the  useful  example  which  he  transmitted  to  his 
successors,  of  searching  on  the  cadaver,  according  to  the  title  of  his 

"  Fernel's  Patliologiaj,  lib.  iii,  cap.  1 

J  De  Abditis  Nonnullis  ac  Mii-andis  ]Morborum  et  Sanationum  Causis,  a  work 
printed  after  the  death  of  Benivieni,  under  the  care  of  his  brother  Jerome. 
Florence,  lo07. 


INTERNAL  PATHOLOGY.  305 

book,  for  the  concealed  causes  of  diseases."  f  Benivieni  did  not  limit 
himself  to  opening  the  bodies  of  his  own  cases  ;  he  sought  occasions 
for  autopsy  with  the  same  ardor  that  c'aracterizes  the  anatomists  of 
our  times.  In  fine,  he  explored  the  bodies  of  those  who  had  been  hung, 
without  any  hope  of  attaching  anatomical  lesions  to  the  symptoms  he 
had  not  been  able  to  see,  but  always  thinking  to  find  on  them  something 
of  interest,  so  as  to  be  able  to  turn  his  researches  to  t'  e  profit  of  descrip- 
tive anatomy  and  physiology."  -  After  him,  Bartholomew  Eustachius 
was  one  of  those  who  showed  most  zeal  in  anatomical  researches.  "We  owe 
to  him  precious  observations  on  the  structure,  functions,  and  diseases, 
of  the  kidneys.  He  shed  on  these  subjects  a  clear  and  new  light.  He 
was  also  the  first  in  modern  times,  who  attempted  to  clear  up  the 
anatomy  and  physiology  of  man,  by  comparing  them  with  that  of  the 
animals. 

After  Eustachius,  we  must  mention,  as  at  the  head  of  the  physicians 
who  cultivated  pathological  anatomy  in  the  sixteenth  century,  Eembert 
Dodoens  and  Marcellus  Donatus.  The  latter  refutes  the  prejudice 
which  in  his  time,  in  many  localities,  still  opposed  autopsies,  in  the 
following  terms :  "  Let  those  who  interdict  the  opening  of  bodies  well 
understand  their  errors.  When  the  cause  of  a  disease  is  obscure,  in 
opposing  the  dissection  of  a  corpse  which  must  soon  become  the  food 
of  worms,  they  do  no  good  to  the  inanimate  mass,  and  they  cause  a  grave 
damage  to  the  rest  of  mankind ;  for  they  prevent  the  physicians  from 
acquiring  a  knowledge  which  may  afford  the  means  of  great  relief, 
eventually,  to  individuals  attacked  by  a  similar  disease.  No  less  blame 
is  applicable  to  those  delicate  physicians,  who,  from  laziness  or  repug- 
nance, love  better  to  remain  in  the  darkness  of  ignorance,  than  to 
scrutinize,  laboriously,  the  truth  ;  not  reflecting  that  by  such  conduct 
they  render  themselves  culpable  toward  God,  toward  themselves,  and 
toward  society  at  large."  f 

Nevertheless,  pathological  anatomy  had  no  considerable  extension 
during  this  period.  Few  men  cultivated  it  in  a  regular  manner,  and 
the  totality  of  their  discoveries  do  not  constitute  the  elements  of  a 
doctrine ;  but  their  labors  merit  the  attention  of  the  historian,  as 
indicating  a  new  tendency  which  makes  an  epoch  in  science. 


§  III.     NOSOGRAPHY. 

Of  all  the  treatises  that  appeared  during  the  period  we  have  named 
Erudite,  that  of  Fernel  obtained  the  most  universal  and  durable  success. 

"'  Introfluction  to  the  works  of  Pare,  p.  119. 
J  Marcellus  Donatus,  Medica  Historia,  lib.  vi. 


306  ERUDITE   PERIOD. 

It  became  classic  throughout  Europe.  It  is,  in  fact,  the  complete  and 
lucid  resume  of  the  Galeuo-Arabic  doctrine,  at  that  time  taught 
exclusively,  in  the  schools  of  Medicine.  In  reading  the  work  of  Fernel, 
we  can  form  a  correct  idea  of  the  manner  in  which  diseases  were  studied, 
at  that  epoch,  and  the  general  state  of  the  science.  On  this  account  it 
merits  a  special  attention  on  our  part,  and  we  proceed  to  present  a  short 
analysis  of  it. 

Fernel  has  included  pathology  entire  in  seven  books.  The  first 
three  are  devoted  to  the  most  abstruse  generalities  concerning  the 
essence  of  diseases,  their  causes,  signs,  and  symptoms.  The  author 
explains  each  of  these  with  much  subtility  ;  he  traces  the  rules  which 
he  believes  infallible,  in  order  to  arrive  at  a  knowledge  of  them  in 
every  instance.  The  material  contained  in  these  three  books  embraces 
all  the  questions  relative  to  etiology  and  semeiotics,  and  forms  a 
treatise  on  general  pathology.  We  will  recur  to  it  in  speaking  of 
theories. 

The  last  four  books  include  particular  descriptions  of  all  diseases  then 
known,  and  their  methodic  classification,  which  constitutes  nosography 
proper.  The  diseases  to  which  men  are  subject  are  therein  classified  as 
general  and  special;  the  former  includes  those  whose  locality  is  unde- 
termined, (morbi  incertae  sedis)  and  the  latter,  those  which  appertain 
to  a  part,  or  to  an  organ,  exclusively. 

The  first  class,  then,  or  general  diseases,  only  comprehends  fevers,  of 
which  Fernel  admitted  three  genera,  viz :  simple,  putrid,  and  pesti- 
lential. Each  of  these  genera  was  subdivided  into  a  small  number  of 
species  or  types,  to  the  description  of  which  the  fourth  book  on  patho- 
logy is  devoted. 

The  second  class,  or  special  diseases,  is  also  divided  into  three  orders, 
viz.:  First,  diseases  which  afi"ect  a  part,  situated  above  the  diaphragm. 
Secondly,  those  aff'ecting  parts  below  that  partition.  Lastly,  external 
or  surgical  diseases.  The  description  of  morbid  species,  comprised  in 
these  three  orders,  fill  the  last  three  books  on  pathology,  viz.:  the  fifth, 
sixth,  and  seventh. 

Notwithstanding  its  defects,  the  nosological  classification,  at  which 
we  have  just  glanced,  was  very  superior  to  all  those  which  had  preceded 
it.  It  possessed,  in  a  very  high  degree,  the  merit  of  clearness  and  pre- 
cision, which  is  an  essential  quality  in  a  work  of  this  kind.  At  that 
time,  considered  in  regard  to  cotemporaneous  science,  it  included,  easily, 
all  the  derangements  of  health.  Such  a  division  of  diseases  sufiiced  for 
the  epoch  in  which  it  was  proposed ;  but  science  has  greatly  enlarged 
since  that  time,  so  that  now  the  nosography  of  Fernel  is  extremely 
defective.     I  shall  not  attempt  to  point  out  its  numerous  imperfections. 


INTERNAL   PATHOLOGY.  307 

but  will  signalize  one  only,  extremely  grave,  whicli  the  author  might 
have  avoided. 

In  all  nosography  the  important  capital  condition  consists  in  portray- 
ing, exactly,  the  morbid  species,  and  tracing  the  characters  of  each  of 
them  so  faithfully,  that  the  practitioner  can  not  confound  them  with 
each  other.  Kow,  the  work  of  the  Trench  nosologist  is  especially  de- 
fective, in  this  respect ;  his  descriptions  are  insufficient,  too  short,  and 
sometimes  worthless.  He  makes  no  special  mention  of  eruptive  fevers, 
nor  of  other  affections  then  newly  observed;  such  as  scurvy,  hooping- 
cough,  raphania,  or  cereal  convulsions,  etc.  He  names,  among  new 
affections,  nothing  but  syphilis,  of  which  he  gives  a  sufficiently  exact 
description,  though  rather  too  succinct.  In  regard  to  the  known  ancient 
diseases,  instead  of  taking  for  models  the  tableaux  of  Aretgeus,  Ca4ius 
Aurelianus,  and  Alexander  of  Tralles,  he  adopts,  a  little  too  servilely, 
the  ideas  and  method  of  Galen ;  besides,  his  descriptions  are  generally 
inferior  to  the  authors  we  have  just  named,  as  may  be  judged  by  the  fol- 
lowing example: 

"Peripneumonia,"  says  Fernel,  '-is  a  phlegmasia  of  the  lungs,  which 
is  related  sometimes  to  phlegmon,  and  sometimes  to  erysipelas.  There  is 
great  difficulty  in  respiration ;  the  cheeks  are  a  bright  red ;  the  eyes 
appear  swollen  and  prominent.  If  the  inflammation  is  phlegmonous, 
the  patient  spits  blood,  according  to  Hippocrates,  unless  the  expectora- 
tion is  extremely  crude.  He  feels  a  constriction  under  the  hypochon- 
dria and  throughout  the  chest,  a  great  weight  beneath  the  sternum,  and 
in  the  back ;  the  fever,  however,  is  moderate.  AVhen  the  inflammation 
is  erysipelatous,  the  cough  brings  up  yellow  matter,  mingled  with  a 
little  blood ;  the  tightness  of  the  chest  and  the  sensation  of  weight  are 
less,  but  there  is  more  fever. 

"  These  two  forms  of  fever  arise  sometimes  primitively,  and,  again, 
succeed  an  acute  angina,  or  a  pleurisy,  when  the  humor  is  thrown  sud- 
denly from  the  throat  or  the  side  upon  the  lungs.  According  to 
Hippocrates,  a  peripneumonia  which  proceeds  from  an  inflamed  side  is 
bad ;  for  if,  in  a  violent  pleurisy,  the  pain  in  the  side  ceases  suddenly,  or 
diminishes  considerably,  it  makes,  ordinarily,  a  metastasis  to  the  lungs  ; 
the  cough  and  suffocation  augment,  or  peripneumonia,  accompanied  by 
a  bloody  expectoration,  appears ;  and  but  few  patients  recover.  "VMien 
peripneumonia  does  not  succeed  another  affection,  but  is  an  original 
affection,  it  is  caused  by  thinness  and  biliousness  of  the  blood,  which  the 
right  ventricle  of  the  heart  throws  vehemently,  and  in  too  large  quan- 
tities, into  the  lungs.  The  blood  fills  up  not  only  the  veins  and  arte- 
ries of  the  organ,  but,  also,  it  invades  the  parenchyma  itself;  it  distends 
it  too  much,  coagulates,  putrefies,  and  lights  up  an  inflammation,  which 


308  ERUDITE  PERIOD. 

is  not  limited,  as  in  other  circumstances,  but  is  diffused  throughout  the 
viscus.  True  peripneumonia  is,  however,  extremely  rare.  Hippocrates 
attributes  it,  especially,  to  drunkenness ;  the  use  of  fish  whose  sticky 
flesh  is  contrary  to  the  nature  of  man,  such  as  the  mullet  and  eel ;  or 
to  the  habit  of  eating  too  much ;  or  to  a  change  of  water.  Sometimes 
a  thin  and  acrid  humor  flows  abundantly  from  the  brain  into  the  lungs, 
assumes  an  unnatural  character,  and  produces  heat  with  fever.  Many 
persons  give  the  name  of  peripneumonia  to  that  species  of  disease  in  which 
the  cough,  the  difiicult  respiration,  and  a  slow  fever  consume  the  patient, 
without  ulceration  of  the  lungs,  or  sanguineous  expectoration.  If  this 
be  called  peripneumonia,  it  must  be  borne  in  mind  that  it  diff'ers  very 
much  from  legitimate  peripneumonia,  in  the  nature  of  the  cause  and  the 
extent  of  symptoms. "=■•'  This  tableau,  it  is  plain,  is  inferior  to  that 
drawn  by  Aretseus  of  the  same  disease,  which  was  heretofore  given. 

About  the  end  of  the  sixteenth,  or  the  commencement  of  the  seven- 
teenth century,  a  Swiss  physician,  named  Felix  Plater,  a  very  distin- 
guished practitioner  and  professor  at  Basle,  published  an  abridgment  of 
Medicine,!  in  which  diseases  are  classified  in  an  entirely  new  manner. 
He  treats,  in  the  first  place,  of  lesions  of  functions,  which  he  divides 
into  lesions  of  sensation  and  lesions  of  motion ;  secondly,  he  speaks  of 
pains,  of  which  he  admits  only  one  kind ;  finally,  he  treats  of  vices, 
which  he  distinguishes  into  vices  of  the  body  and  vices  of  excretions. 
This,  it  is  seen,  is  an  entirely  new  and  very  defective  classification.  AYe 
have  alluded  to  this  book,  less  on  account  of  its  intrinsic  value,  than  as 
a  first  step  in  an  unexplored  route,  where  a  new  era  in  nosography  begins. 
The  author  does  not  class  pathological  affections  according  to  the  pre- 
sumed state  of  the  interior  of  the  body,  i.  e.,  according  the  intimate 
phenomena  which  are  fulfilled,  or  are  supposed  to  be  fulfilled  in  the 
structure  of  the  organs,  but  according  to  the  totality  of  their  apparent 
symptoms. 


CHAPTEE    VI. 

INTERNAL    THERAPEUTICS. 

Everything  in  Medicine  is  connected,  or  should  be  connected  with 
therapeutics.  Ars  medica  est  id  quod  est  propter  thernpeuticen  :  such 
is  the  maxim  that  should  never  be  lost  sight  of  by  men  who  write  on 

*"'  J.  Fernelli,  Pathologiae,  lib.  v,  cap.  x. 

f  Praxeos  sen  de  Cognoscendis,  Curandis  Affectibus  Humani  Incommodantibus 
Tractatus,  Basilce,  1602. 


INTERNAL  THERAPEUTICS.  309 

any  branch  of  the  Healing  Art.  Anatomy,  physiology,  pathology,  etc., 
must  all  converge  toward  therapeutics  as  a  common  center.  Each  of 
these  has  an  eifective  value  only  in  proportion  to  the  succor  it  gives  in 
the  treatment  of  diseases.  This  is  a  truth  which  needs  no  demonstra- 
tion— it  is  barely  necessary  to  announce  it ;  nevertheless,  it  has  been 
forgotten  or  mistaken  sometimes,  by  eminent  minds.  We  see  the  ultra 
sectarians  of  the  autocratism  of  nature,  or  animism,  make  the  perfection 
of  the  Art  consist  in  the  knowing  in  advance  and  predicting  the  course, 
crisis,  and  probable  issue  of  a  disease,  limiting,  to  some  extent,  the 
duties  of  the  physician  to  the  idle  contemplation  of  the  sufferings  of 
the  patient.  We  see  the  blind  partizans  of  another  school  attach  such 
a  high  interest  to  the  determination  of  the  anatomical  lesions  whose 
traces  are  seen  after  death,  that  they  lose  sight  of  the  treatment,  or  say 
a  word  about  it,  for  form's  sake,  and  occupy  themselves  exclusively 
with  the  alterations  observed  in  the  dead  body.  It  is  to  the  zealots  of 
this  school  that  the  sentence  of  Asclepiades  may  be  justly  addressed : 
"  Your  Medicine  is  oaly  meditation  on  death." 

What  are,  in  the  eyes  of  men  matured  by  practice,  and  undeluded  by 
the  pompous  promises  of  anatomism,  what  are,  1  say,  diagnosis  and 
prognosis,  if  their  light  does  not  serve  to  improve  treatment  and  render 
it  more  efficacious  '?  For  the  true  practitioner,  as  well  as  for  the  patient. 
therapeutics  is  the  cap-stone  of  the  Science,  the  criterion  of  the  real 
progress  of  the  Art.  On  this  point  it  merits  a  very  particular  atten- 
tion, and  the  details  into  which  I  proceed  to  enter  on  this  subject,  will 
interest,  I  presume,  those  readers  who  seek  in  this  history  something 
more  than  the  vain  satisfaction  of  curiosity. 

The  epoch  of  the  revival  of  letters  forms,  as  is  shown,  the  limit 
between  the  middle  ages  and  modern  times.  The  physicians  of  that 
famous  epoch  attempted  less  to  create  new  methods  of  treatment,  than 
to  restore  the  ancient  ones ;  they  attempted  to  conciliate  the  Greeks 
with  the  Arabs ;  Galen  with  Avicenna,  and  to  study  their  writings  is 
to  converse  still  with  the  classics  of  antiquity.  It  will  be,  then,  a  last 
glance  which  we  proceed  to  take  of  the  doctrines  of  the  fathers  of  Med- 
icine— a  definite  judgment  which  we  shall  render  on  the  rules  they  have 
transmitted  to  us,  before  passing  to  the  changes  that  the  moderns  have 
thought  it  their  duty  to  make. 

Among  the  writers  of  the  Erudite  Period  who  have  shown  themselves 
zealous  partisans  of  the  Greek  theories,  no  one  has  better  penetrated 
their  spirit  than  John  Fern  el,  no  one  has  succeeded  better  than  he,  to 
attach  to  them  the  practical  facts  of  his  times ;  no  one,  in  fine,  has  con- 
nected with  as  much  art  as  he  the  ancient  theories  with  modern  dis- 
coveries, so  as  to  form  a  complete  body  of  doctrines,  and  develop  clearly 


310  ERUDITE    PERIOD. 

the  principles  for  the  guidance  of  his  cotemporaries  in  the  treatment  of 
diseases.  It  will  be,  then,  in  his  writings  that  we  obtain  the  knowledge 
of  these  principles,  and  the  consequences  that  were  deduced  from  them. 

Fernel  has  divided  his  therapeutics  into  seven  books,  the  same  as  his 
pathology,  following  in  the  two  treatises  an  analogous  if  not  uniform 
plan.  He  explains,  in  the  first  place,  the  generalities,  or  as  was  said 
then,  the  principles ;  afterward,  he  passes  to  the  particular  rules  of 
practice,  and  he  shows  how  each  of  them  is  comprised  in  the  principles 
he  has  established.  Ee  proceeds  constantly  from  generals  to  particu- 
lars, according  to  the  method  of  Aristotle  and  Galen,  to  which  he 
strictly  conforms,  true  Peripatecian  as  he  was. 

Fernel  commences  by  laying  down  the  fundamental  axioms  of  thera- 
peutics, the  pivot  around  which  must  turn  all  the  particular  rules  of 
treatment,  which  axiom  was  nothing  else  than  the  famous  law  of  con- 
trarieties, which  we  have  already  brought  before  our  readers  and  dis- 
cussed, but  which  we  have  promised  to  submit  anew  to  a  more  thorough 
examination.  The  time  has  now  arrived  to  devote  ourselves  to  this 
examination,  because  no  author,  ancient  or  modern,  has  supported  this 
great  axiom  with  as  numerous,  subtile,  and  specious  arguments  as  ker- 
nel. He  opens  the  subject  as  follows:  '' Every  disease  must  be  com- 
batted  hj  contrary  remedies — for  a  remedy  is  that  which  can  drive  out  a 
disease ;  now,  that  which  drives,  acts  violently — that  which  uses  vio- 
lence, is  in  opposition :  therefoi-e,  the  remedy  is  always  opposed  to  the 
disease,  and  no  healing  can  take  place  except  in  virtue  of  the  law  of 
contraries."" 

This  argument,  notwithstanding  its  apparent  precision  and  its  scho- 
lastic form,  is  evidently  a  begging  of  the  (juestion.  It  amounts  to  this : 
diseases  must  be  combatted  by  their  contraries,  since  all  that  cures  a 
disease  is  contrary  to  it.  But  is  it  not  plain  that  he  offers  as  a  reason, 
and  alleges  as  proof,  the  veiy  thing  itself  which  he  undertakes  to  prove  ? 
It  is  affirmed  that  all  that  cures  a  disease  is  contrary  to  it,  and  that  is 
really  what  should  be  proved.  This  reasoning  reminds  us  very  much  of 
that  which  a  celebrated  comic  poet  puts  sometimes  in  the  mouths  of  his 
characters,  as,  for  example,  when  he  makes  one  of  them  say,  "  your 
daughter  is  dumb  because  she  does  not  speak. '"f  Such  is  the  sophism 
with  which  one  of  the  loftiest  intelligences  of  the  sixteenth  century 
deceived  himself,  and  imposed  on  the  whole  Medical  world  I 

Fernel,  however,  did  not  content  himself  with  the   subtile  and  arid 

'Joanis  Feruelii,  Theraj^euticus  Universalis,  sen  Method!  Medendi,  lib.  i. 
cap.  HI. 

f  Moliere,  dans  la  Comedie  du  Medecin  malgre  lui. 


INTERNAL  THERAPEUTICS.  311 

argumentation  which  we  have  given  above.  He  knew  too  well,  that  a 
rule  of  medicine  must  be  verified,  especially,  by  practice,  consequently, 
he  essayed  to  demonstrate  that  each  particular  case  of  healing  enters, 
necessarily,  into  the  law  of  contraries.  Let  us  follow  him  as  he  devel- 
opes  this  law.  We  call  contraries,  he  says,  not  only  those  things  which 
are  endowed  with  opposite  elementary  qualities,  as  heat  and  cold,  dry 
and  wet,  but  also,  all  things  which  differ  among  themselves  in  any  way, 
whether  as  to  quantity,  number,  situation,  figure,  etc.  Thus,  the  hard 
and  the  soft ;  the  dense  and  the  difi"use ;  the  great  and  the  small ;  that 
which  is  in  excess,  and  that  which  is  deficient ;  the  high  and  the  low ; 
the  full  and  the  empty ;  what  is  pure,  and  what  is  impure ;  that  which 
is  entire,  and  that  which  is  broken ;  such  as  these  are  what  Fernel 
understands  as  contraries. 

The  above  is  an  example  of  the  puerile  subtilties  into  which  a  supe- 
rior mind  is  forced  to  descend,  when  it  proceeds  upon  a  false  principle. 
According  to  the  language  of  Fernel,  a  drop  of  water  would  be  the  oppo- 
site of  a  lake;  a  giant  the  opposite  of  a  dwarf;  a  pitcher  empty,  the 
opposite  of  a  full  one  ;  a  mountain  the  opposite  of  a  valley,  etc.  Who 
does  not  see,  at  the  first  glance,  that  these  are  the  opposites  of  the 
painter,  the  poet,  or  the  rhetorician,  or,  in  other  terms,  contrasts ;  but 
not  at  all  real  opposites,  founded  on  the  antagonisms  of  forces,  or  ele- 
mentary properties,  according  to  the  understanding  of  physicians,  phi- 
losophers, and  mathematicians  ?  In  the  language  of  these,  the  term 
contrary  is  applied  either  to  qualities  which  neutralize  each  other, 
such  as  heat  and  cold,  dry  and  moist,  or  to  forces  which  act  in  a  manner 
diametrically  opposite,  such  as  the  south  and  north  wind,  and  the  cen- 
tripetal and  centrifugal  forces. 

In  giving  to  the  word  contrary,  the  unlimited  extension  of  our  thera- 
peutist, we  make  it  the  synonym  of  the  word  different,  but  then  the 
famous  precept  to  treat  diseases  by  contrary  remedies,  signifies  nothing 
else  than  to  treat  them  by  remedies  which  differ  from  the  disease  itself, 
or  its  cause,  which  amounts  almost  to  nonsense.  Such  an  axiom  is  not 
worth  the  trouble  of  being  laid  down,  and  certainly  this  is  not  the  sense 
which  the  early  writers,  such  as  Hippocrates,  Galen,  and  their  innu- 
merable ancient  and  modern  sectators  attach  to  it.  When  these  advised 
to  give  in  each  affection  remedies  contrary  to  the  disease,  they  meant 
remedies  whose  properties  or  curative  virtues  would  be  in  opposition, 
real  or  direct,  with  the  hidden  cause  or  principle  of  the  disease.  It 
results  from  this,  that  Fernel,  in  order  to  justify  his  fundamental  dogma 
of  medical  practice,  is  obliged  to  torture  the  sense  of  words,  after  hav- 
ing tortured  logic. 

Moreover,  notwithstanding  the  exorbitant  extension  which  was  given 


313  ERUDITE   PERIOD. 

to  the  word  contrary,  this  author  still  fearing  that  his  therapeutical 
axiom  did  not  embrace  every  possible  case  of  cure,  hastens  to  go  beyond 
all  the  doubts  and  objections  that  could  be  given  to  it  by  the  following 
interpretation:  "  Many  men  conceive  that  this  sovereign  principle  is 
annulled,  when  it  is  said,  that  there  are  diseases  which  are  cured  by 
similars :  but  these  persons  do  not  reflect  that  such  remedies,  though 
apparently  similar  in  their  effects,  to  the  symptoms  of  the  disease,  are 
opposed  to  the  causes  which  produced  it,  so  that  they  destroy  the  disease 
by  removing  its  cause ;  thus,  rhubarb,  though  heating,  extinguishes 
fever  by  purging  the  matter  which  feeds  the  fire.  Exercise  fatigues  us 
by  aiding  the  elimination  of  the  humors  efi"used  into  the  muscle.  A 
purgative  arrests  a  dysentery  by  evacuating  the  peccant  matter,  which 
causes,  and  sustains  it.'- 

Certainly,  Fernol  has  interpreted  the  axiom  of  contraries  in  a  way 
so  wide  and  flexible,  that  it  is  impossible  to  suppose  a  case  of  cure  which 
is  not  comprised  in  it.  Order  whatever  remedy  you  please ;  employ  any 
curative  procedure  of  which  you  may  get  an  idea ;  if  the  remedy  or  pro- 
cedure is  successful,  according  to  Fernel,  it  will  be  always  on  the  prin- 
ciple of  contraries,  even  if  there  should  be  identity  between  the  cause 
of  a  disease  and  the  means  of  cure ;  as  when  we  cause  the  pain  in  a 
small  burn  to  cease,  by  heating  the  burnt  part  for  an  instant  at  the  fire ; 
or  when  the  frozen  fingers  are  warmed  by  rubbing  them  with  snow. 

But  let  us  leave  these  vain  artifices,  which  have  not  caused  ancient 
science  to  advance  an  iota,  and  let  us  explain  how  it  happened  that  so 
many  eminent  men,  with  their  light,  could  content  themselves  with  it, 
during  a  long  series  of  ages.  In  clearing  up  this  psychological  phe- 
nomenon in  one  single  individual,  we  do  it  for  all.  Feruel  possessed  a 
mind  essentially  logical.  Before  embracing  the  profession  of  medicine, 
he  was  distinguished  by  his  discoveries  in  mathematics  and  astronomy. 
When  he  emitted  a  principle  which  he  believed  well  founded,  he  pushed 
it  to  its  last  consequences,  as  do  all  minds  of  his  stamp.  Now,  in  his 
philosophical  and  medical  education  he  had  acquired  a  great  veneration 
for  the  ancients ;  he  could  not  persuade  himself  that  a  principle  adopted 
almost  unanimously  by  the  most  sublime  geniuses  of  antiquity — by 
Hippocrates,  Aristotle,  Galen,  and  so  many  others — as  the  basis  of  phy- 
sics and  medicines  could  be  false.  To  doubt  the  infallibility  of  the 
axiom  of  contraries,  was  to  sap  the  foundation  of  the  elementary  theory 
of  Plato  and  Aristotle,  as  well  as  the  thereapsutics  of  Galen.  A  single 
man  was  not  capable  of  so  grand  an  effort :  it  required  generations  for 
that,  as  the  result  of  this  history  shall  show.     Fernel  admitted,  then, 

'^  Method!  Medendi,  lib.  i,  cap.  ii. 


INTERNAL  THERAPEUTICS.  313 

the  principle  of  contraries,  as  an  article  of  faith ;  in  place  of  discussing 
it  with  complete  independence  of  mind,  he  exerted  himself,  only,  to  seek 
arguments  to  convince  himself  and  others  of  its  reality.  Could  he 
foresee  that  before  an  age  this  famous  law  of  contraries,  by  which 
physicians  and  natural  philosophers  explained  at  that  time  the  phe- 
nomena of  nature,  would  be  banished  from  the  domain  of  physics  and 
chemistry,  and  replaced  by  the  law  of  affinities ;  in  other  words,  that 
thereafter  the  composition  and  decomposition  of  bodies,  their  formation 
and  their  destruction,  would  only  be  explained  by  the  affinities  more  or 
less  great  of  their  material  elements  ?  Could  he  presume  that  experi- 
mental analysis  would  be  substituted  by  the  chemists,  at  a  future  time, 
for  the  mental  analysis  of  the  philosophers  ;  that  the  number  of  elements 
would  increase  in  a  manner  indefinitely,  and  the  qualities  of  the  ele- 
ments would  no  longer  present  the  pretended  antagonism  imagined  by 
the  ancients  ?  Fernel,  then,  had  only  to  believe  and  repeat  an  old  error 
which  time  had  sanctioned,  and  which  seemed  to  preclude  all  discussion  ; 
but  he  had  the  advantage  over  most  of  those  who  professed  the  same 
faith  with  him  in  medicine,  of  endeavoring  to  sound  to  the  bottom  of 
science,  and  of  seeking  to  strengthen  his  faith  by  proofs,  which,  in 
their  turn,  have  furnished  us  the  occasion  to  refute  him. 

OBJECTION. 

If  you  overturn,  say  some,  the  fundamental  dogma  of  ancient  thera- 
peutics, if  you  pretend  that  remedies  do  not  cure  diseases  by  properties 
contrary  to  them,  then  say  by  what  virtue  do  they  cure:  is  it  by  prop- 
erties similar  to  those  of  the  morbific  cause,  or  solely  diverse?  For 
remedies  can  only  act  in  three  ways — by  antipathy,  homoeopathy,  or  by 
some  virtue  which  may  be  neither  antipathic  nor  homoeopathic,  but  only 
different,  that  is  to  say,  allopathic.  Which  one  then,  of  these  three 
modes  of  action,  must  we  choose,  in  the  treatment  of  diseases  ? 

An  ancient  author,  whose  authority  I  have  often  invoked,  answers  for 
me  this  question.  We  read  in  the  Hippocratic  treatise  on  Ancient 
Medicine:  "diseases  are  cured  sometimes  by  contraries,  sometimes  by 
similars,  and  sometimes  by  remedies  the  action  of  which  is  neither  con- 
trary nor  similar,  but  operate  in  an  inexplicable  manner.  There  is  no 
fixed  rule  on  this  subject." 

The  author  of  the  treatise  "  On  Diseases,"  professes  the  same  opinion 
as  the  above:  "there  is,"  he  says,  "no  manifest  principle  of  cure  that 
may  be  properly  termed  a  universal  principle  for  every  case  to  which 
our  Art  is  applicable." - 

If  there  is  no  fixed  rule,  then,  replies  our  censor.  Medicine  is  not  an 

^  Traite  de  1'  Ancienne  Medecine,  liv.  i.  §  ii,  translation  of  Gardeil. 

20 


314  ERUDITE  PERIOD. 

Art,  and  the  treatment  of  diseases  is  subject  to  the  caprices  of  the  phy- 
sician ;  and  their  cure  depends  entirely  on  chance,  not  on  the  observation 
of  rules. 

This  is  a  grave  accusation,  and  one  which  has  rested  for  a  long  time 
against  Medicine.  My  confreres,  I  presume,  will  not  be  angry,  if  I  make 
a  peremptory  response  to  it.  Before  there  were  any  physicians,  and 
before  any  discoveries  had  been  made  of  the  properties  of  any  medica- 
ment, how  were  the  sick  treated  ?  Every  one  treated  them  according  to 
his  fancy  or  instinct,  or  they  had  the  counsel  of  some  neighbor  or  passer 
by,  who  knew  no  more  about  it  than  they,  not  having,  himself,  any  other 
guide  than  a  very  questionable  experience.  But  when  the  efficacy  of 
certain  remedies  had  been  established  by  repeated  trials  in  certain  dis- 
eases, thereafter  they  did  not  fail  to  administer  the  same  remedies  when- 
ever the  same  diseases  were  presented.  The  number  of  known  diseases 
and  remedies  then  experimentally  ascertained,  being  very  much  increased 
in  the  course  of  ages,  men  made  a  particular  study  of  them,  and  col- 
lected their  knowledge  in  a  body  of  doctrines.  Then  Science  and  Art 
were  constituted,  and  then  only  they  began  to  reason  on  the  essence  of 
diseases,  and  the  mode  of  action  of  remedies.  This  reasoning  might 
possibly  contribute  to  the  perfection  of  the  science,  but  it  did  not  consti- 
tute it,  nor  form  its  base.  The  true  foundation  of  practical  j\Iedicine 
was,  and  still  is,  observations,  collected  from  age  to  age,  from  which  it 
results,  that  such  a  mode  of  treatment  cures,  or  relieves,  such  a  species 
of  disease  more  efficaciously  than  any  other  known  means.  If,  now,  it 
is  asked,  in  virtue  of  what  rational  principle  the  practitioner  is  sup- 
posed to  act,  when  he  rejects  the  action  of  contraries,  and  the  action  of 
similars,  it  will  be  easy  to  respond — in  virtue  of  that  incoutestible  and 
incontested  principle,  that  diseases  must  he  treated  hy  remedies  which 
have  heen  experimentally  recognised  as  the  most  e^cacious. 

What  more  can  be  required  of  a  physician  who  is  called  to  see  a 
patient,  than  that  he  discern  clearly  the  affection  before  him,  and  bring 
to  bear  all  the  light  that  commemorative  and  present  circumstances  can 
furnish  him,  and  that  he  then  employ  the  curative  means  which  the 
observation  of  all  ages,  deposited  in  the  writings  of  the  masters,  and 
confirmed  on  suitable  occasions  by  his  own  experience,  demonstrates  to 
possess  the  most  efficacy  in  such  a  case.  This  is  all  that  can  be 
demanded  of  a  physician,  and  it  is  of  little  import  to  the  patient  whether 
he  is  cured  by  antipathy,  homoeopathy,  or  allopathy :  the  essential  thing 
for  him  is,  to  be  treated  by  the  method  which  experience  has  proved  to 
be  the  best. 

Thus,  then,  in  reversing  the  dogma  of  co7itraries,  we  do  not  sap  the 
scientific  edifice  of  Medicine,  nor  do  we  bi'eak  the  chain  of  tradition  ;  but 


INTERNAL   THERAPEUTICS.  315 

we  restore  tlie  practice  of  medicine  to  its  real  basis,  experience,  and  iu 
this  way  go  back  to  the  primitive  traditions,  whicb  the  fictions  of  the 
philosophers  had  obscured.  In  this  system — for  Empiricism  is  one,  and 
even  the  most  rational,  as  will  appear  more  and  more,  in  proportion  as 
we  shall  advance  in  this  history — in  this  system,  I  say,  we  do  not  com- 
mence the  science  with  Hippocrates,  Diodes,  Hcrophilus,  Serapion,  or 
any  other  celebrated  physician,  but  we  begin  with  the  origin  of  time. 
Neither  does  this  system  conduct  us  to  the  following  conclusion  of  a 
distinguished  professor  of  the  school  of  Paris,  which  I  have  read  with 
alarm,  and  which  he  has  let  fall  from  his  pen,  doubtless,  by  inadvertence : 
"  Bichat  has  very  well  established,"  says  this  professor,  "  that  all  the 
systems  of  pathologj-  have  influenced  therapeutics,  and  as  these  systems 
were  often  tarnished  with  error,  the  therapeutics,  which  were  only  a  con- 
sequence, and,  as  we  may  say  the  conclusion  of  them,  must  be  equally 
false,  bad  or  injurious.  It  is  a  great  misfortune,  certainly,  but  it  was 
inevitable,  and  it  will  recur  unceasingly,  until  the  time  when  we  shall 
have  ideas  that  are  perfectly  correct,  on  the  nature  of  diseases ;  and  not 
treat  diseases  without  having  regard  to  their  nature,  which  is  as  absurd 
as  it  is  impossible.""  Empiricism  conducts,  logically  and  historically, 
to  the  following  conclusion,  which  is  less  absolute  and  more  consoling 
and  true :  The  knowledge  of  physicians  in  former  times  was  very  imper- 
fect, yet  they  knew  how  to  cure  certain  diseases,  Now,  we  know  a 
greater  number  less  imperfectly,  and  we  have  still  more  extended  knowl- 
edge of  the  means  for  their  cure  ;  and  those  who  shall  succeed  us  will 
have  still  more  extended  and  sure  means  than  ours.  According  to  this 
doctrine,  we  do  not  say  oui-  predecessors  had  only  false  ideas  on  the 
nature  of  diseases,  that  is  to  say  on  the  totality  and  corelation  of  their 
phenomena ;  but  we  say,  our  predecessors  had  notions  more  limited 
than  ours,  on  the  nature  of  diseases ;  and  in  proportion  as  the  human 
race  shall  improve,  it  is  probable  that  the  notions  acquired  will  be 
extended  and  perfected  more  and  more,  for  each  day  we  discover  new 
phenomena  in  the  diseases  already  observed,  and  new  means  of  curing 
them,  or  to  prevent  some  of  their  symptoms. 

There  exist,  then,  and  there  have  existed  from  time  immemorial, 
rules  of  medical  practice,  founded  on  the  pure  and  simple  observation 
of  phenomena,  independent  of  all  interpretation,  true  or  false,  judicious 
or  extravagant,  of  those  phenomena ;  in  other  words,  free  from  all  specu- 
lation on  the  essence  of  diseases,  and  on  the  intimate  action  of  remedies. 
These  rules  are  not  unchangeable,  but  they  change  and  improve  in  pro- 
portion as,  by  more  careful  and  delicate  observation,  new  objects  are 


Bouillaud,  Essai  de  Philosopliie  Medicale,  3e  partie,  chap,  vi,  art.  1. 


316  ERUDITE   PERIOD. 

discovered,  iinperceived  or  neglected  heretofore.  Nor  are  rules  arbi- 
trary, for  they  must  have  been  sanctioned  by  experience.  Those  who 
conform  to  them  cannot  be  accused  of  acting  in  a  hazardous  manner, 
because  they  know,  in  advance,  the  probabilities  of  success  they  offer, 
and  their  therapeutics  cannot  be  charged  with  being  bad  or  injurious, 
because  it  is  the  best  and  the  most  successful  known  at  the  time. 

I  had  terminated  my  refutation  of  the  axiom  of  contraries,  when  I 
read  in  the  translation  of  the  works  of  Hippocrates  by  M.  Littre,  an 
extract  from  a  work  published  in  Germany,  on  the  same  subject.  As 
we  cannot  have  too  much  light  on  these  subjects,  when  it  is  a  cjuestion 
of  condemnation  of  an  opinion  almost  universally  embraced  by  antiquity, 
and  sustained  to  our  day  by  respectable  authorities,  I  have  been 
charmed  with  the  reading  of  this  work,  which  arrives  at  the  same  con- 
clusion as  my  own,  though  elaborated  in  a  different  way,  and  presented 
under  another  color.  I  give  the  remarkable  fragment  as  M.  Littre  has 
reproduced  it,  and  I  hope  it  will  afford  the  same  pleasure  to  my  readers 
as  to  myself:  "We  think  we  are  able  to  sustain,"  says  M.  F.  "W. 
Becker,  "  that  the  hypcnantiose,  or  the  principle  contraria  contrariis 
curantur,  does  not  rest  on  experience,  free  from  hypothesis — that  it 
originated  in  the  mechanico-chemical  manner,  in  which  life  was  sup- 
posed to  exist,  and  thus  it  falls  with  this  view.  When  an  opposition 
seems  to  exist  between  a  disease  and  the  remedy,  it  is  only  in  appear- 
ance, and  not  in  reality.  We  propose  to  establish  this  by  examples 
drawn  from  the  different  methods : 

"  We  observe  that  an  indisposition  produced  by  a  surcharge  of  the 
stomach  is  cured  by  dieting ;  that  a  disease  of  the  skin  produced  by 
uncleanliness,  is  cured  by  bathing ;  that  a  man  fatigued  by  excessive 
efforts,  is  refreshed  by  repose.  At  the  first  glance  it  certainly  seems, 
that  there  is,  here,  an  opposition  between  the  disease  and  the  treat- 
ment ;  but,  in  fact,  the  cure  is  the  result,  not  of  a  veritable  opposi- 
tion, but  of  the  removal  of  the  cause  which  produced  the  evil,  or 
aggravated  it,  and  of  the  restoration  of  the  organism  to  a  condition 
favorable  to  the  exercise  of  its  recuperative  powers. 

"  We  see,  also,  that  the  end  of  the  treatment  is  obtained  by  arousing 
or  re-exciting,  by  external  means,  the  diminished  or  suspended  function : 
constipation  is  cured  by  evacuants  ;  atonic  ulcers  are  put  in  the  way  of 
cure  by  exciting  ointments  ;  a  fever,  with  a  small  pulse,  is  cured  by  the 
use  of  wine,  which  excites  a  fullness  of  the  pulse.  These  are  some  of 
the  phenomena  which  have  been  brought  forward  to  prove  the  principle, 
contraria  contrariis  curantur.  But  it  is  easy  to  prove  that  in  any  one 
of  these  cases,  or  in  others  to  which  the  method  termed  excitant  is 
applied,  the  vital  activity  is  not  absolutely  augmented.      All  these 


\ 


INTERNAL  THERAPEUTICS.  317 

modes  of  treatment  are  not  founded  on  tlie  opposition  of  the  medica- 
ment to  the  disease,  but  on  the  result  of  experience — particular  and 
very  important  physiological  results,  namely,  that  the  organism,  when 
an  action  is  excited  in  it,  produces,  at  the  same  time  with  this  action, 
and  on  account  of  it,  similar  or  identical  actions.  It  seems,  that  when  a 
function  is  morbidly  increased,  the  cure  must  be  sought  in  the  diminu- 
tion of  that  activity ;  and  it  is  pretended  that  there  is  hypenantiose  in 
such  a  case.  But  the  functions,  in  such  a  morbid  state,  are  the  objects 
of  a  depressing,  sedative  treatment,  not  because  they  vary  from  the 
laws  of  health,  but  simply  because  they  become  the  occasion  of  other 
morbid  states,  which  menace  the  organ,  or  the  organism.  We  do  not 
arrest  a  diarrhea  with  opium  because  the  intestinal  evacuations  are 
more  frequent  or  more  abundant  than  in  a  state  of  health,  (for  many 
diarrheas  may  be  left  to  the  control  of  nature,  and  some  are  even 
treated  by  purgatives,)  but  we  give  opium  in  the  case  when  we  have 
reason  to  fear  the  prolonged  evacuations  may  determine  an  inanition,  or 
the  exhaustion  of  the  entire  organism.  We  do  not  prescribe  digitalis, 
which  reduces  the  pulse,  because  the  pulse  is  frequent,  (for  in  every 
accession  of  fever,  when  the  pulse  is  no  less  frequent,  we  do  nothing  for 
the  symptom,)  but  simply  in  cases  where  the  shock  of  the  blood  excites 
the  fear  of  a  derangement  in  the  movements  of  the  li(|^uid,  or  in  the 
texture  of  the  heart,  vessels,  or  lungs. 

"  Besides  the  three  classes  of  curative  methods  indicated  thus  far — 
dietetic,  excitant,  and  sedative — all  of  which  have  a  direct  relation  to 
vital  activity,  there  are  still  two  others,  namely,  those  which  act 
immediately  on  the  mass  and  the  movement  of  the  blood,  (as  emission, 
infusion,  transfusion,  haemostasis,  ligation,  etc.,)  and  those  which 
change  the  form  of  the  solid  parts,  as  surgical  operations.  To  these 
two  classes,  the  principle  contraria,  etc.,  is  as  little  applicable  as  to 
the  preceding  ones,  and  we  have  always  particular  ends  in  view,  which 
are  attained  by  the  immediate  action,  on  the  liquid  or  solid  substances 
of  the  organism. 

"  If,  then,  contraria  contrarns  curantur  is  not  founded  on  pure 
experience — if  it  has  the  appearance  of  truth  only  in  the  eyes  of  those 
who  mistake  the  true  connection  between  a  disease  and  its  cure — how 
is  it,  that  this  principle,  which  has  been  so  universally  recognized,  from 
the  ancients  down  to  Paracelsus,  has,  notwithstanding  its  victorious 
refutation  by  reformers  of  past  times,  assumed  again  an  authority  so 
general  ?  We  think  the  reason  may  be  found  in  the  necessary  connec- 
tion in  which  hypenantiose  stands,  as  a  therapeutic  principle,  with  the 
mechanical  and  chemical  manner  in  which  most  objects  in  physiology 
and  pathology  are  represented.     This  mode  of  representation,  though 


318  ERUDITE    PERIOD. 

refuted  in  different  ways,  in  its  primary  and  grosser  forms,  and  replaced 
by  organic  Medicine,  is  still  frecjuently  reproduced  in  medical  history, 
in  other  forms,  less  definite,  and,  it  appears,  more  scientific.  The  h pen- 
antiose  which  constantly  accompanies  it  must  maintain  an  extraordinary 
influence,  and  we  are  led  to  think,  that  this  influence  will  be  abolished, 
only  when  it  shall  have  been  understood  what  is  the  subordinate  rank 
which  mechanics  and  chemistry  hold  in  physiology."  '■■■■ 

Another  reason  why  the  principle,  contraria  contrariis  curantur, 
preserved,  and  still  preserves  much  of  its  authority,  notwithstanding 
its  more  or  less  victorious  refutation  at  different  times,  arises  from  the 
fact  that  its  adversaries  have  substituted  nothing  which  can  take  its 
place.  Now,  in  a  science  of  daily  and  urgent  application,  like  Medi- 
cine, it  does  not  suffice  to  prove  that  a  doctrine  is  doubtful,  or  false,  or 
incomplete ;  it  is  necessary  at  once  to  present  in  its  stead  one  surer, 
truer,  and  more  general ;  this  is  what  no  one  has  yet  done,  not  even  the 
author  of  the  extract  I  have  just  quoted,  who  thinks  that  the  hypenan- 
tiose  will  not  lose  its  influence  until  it  shall  be  in  accordance  with  the 
subordinate  rank  that  mechanics  and  chemistry  hold  in  physiology, 
which  is  probably  to  await  the  coming  of  the  Greek  Kalends.  The 
animists,  vitalists  or  modern  Hippocratists,  have  attempted  to  substi- 
tute for  the  axiom  of  contraries  that  of  coction  and  crisis,  or  the  auto- 
cratism  of  nature ;  but  we  shall  demonstrate,  in  the  next  period,  that 
the  theory  of  the  autocratism  of  nature  is  very  far  from  embracing  all 
cases  of  cures,  all  modes  of  treatment,  and  we  shall  then  propose 
another  therapeutic  axiom,  more  sure,  more  evident,  and  more  general 
than  any  of  those  that  have  been  proposed  up  to  this  time. 

After  this  somewhat  long,  but  necessary  digression,  in  view  of  the 
importance  of  the  subject,  I  return  to  the  examination  of  the  therapeu- 
tic doctrine  of  Fernel.  The  second  precept  which  this  author  gives, 
relates  to  expectorant  medicine,  which  seems  to  me  is  worthy  of  all 
approbation,  as  it  circumscribes  the  employment  of  that  method  within 
just  limits.  When  a  disease,  he  says,  is  not  well  known  to  you,  and 
you  do  not  see  clearly  its  nature,  do  not  be  in  haste  to  apply  remedies  ; 
let  nature  conduct  the  case  for  a  season  if  there  be  no  urgency,  for 
nature,  aided  by  a  suitable  regimen,  will  cure  the  affection,  or  declare 
its  true  character.  A  doubtful  and  vain  medication  is  nearly  always 
injurious.  In  fine,  if  you  are  forced  to  attempt  something,  do  it  with 
circumspection,  in  such  a  way  as  not  to  cause  a  grave  prejudice  to  the 
patient. 

'■'  Berliner  Med.  Zeitung,  1834:,  p.  15.  CEuvres  Hippocratiques,  T.  IV,  de  M 
Littre,  p.  520.     Aphorismes,  Argument,  §  13. 


INTERNAL  THERAPEUTICS.  319 

Another  recommendation  on  which  Fernel  insists  very  much,  is,  to 
endeavor  to  destroy  the  cause  or  causes  of  any  disease,  before  attacking 
the  disease  itself.  This  recommendation  forms  one  of  the  capital 
points  of  his  therapeutic  doctrine,  and  he  sustains  it  by  considerations 
that  may  be  thus  summed  up :  While  the  cause  of  a  disease  exists,  the 
affection  derived  from  it  can  not  be  completely  uprooted — it  recurs 
unceasingly ;  on  the  other  hand,  after  the  extirpation  of  the  cause,  the 
disease  will  often  cease  of  itself,  unless  it  be  too  inveterate.  Again,  it 
must  be  remarked  that  there  is,  in  certain  affections,  not  a  single  cause, 
but  a  series  of  causes,  which  it  is  necessary  to  destroy  successively, 
according  to  the  order  of  their  development,  that  is,  to  commence  with 
the  first,  or  oldest,  and  finish  with  the  last,  or  most  recent.  This, 
exclaims  Fernel,  is  what  is  termed  a  methodic  cure,  a  cure  which  does 
not  consist  simply  in  the  employment  of  such  or  such  a  remedy,  but 
also  in  the  manner  and  order  of  proceeding." 

He  quotes,  in  the  same  chapter,  several  examples  of  this  curative 
method,  from  among  which  I  extract  the  following,  which  is  one  of  the 
most  simple.  Suppose  that  by  prolonged  use  of  a  diet  too  heating, 
there  should  be  formed  in  the  stomach  an  acrid  chyle,  which,  carried  to 
the  liver,  creates  there  an  excessive  quantity  of  bile  and  vicious  humors. 
These,  after  having  passed  from  the  great  veins  into  the  less,  are  easily 
vitiated,  and  give  rise  to  all  the  symptoms  of  fever.  Now  it  is  certain 
that  we  can  not  calm  the  symptoms  of  this  fever  without  having  previ- 
ously evacuated  the  putrid  matter  which  gives  rise  to  it.  To  eliminate 
properly  the  putrid  matter,  it  is  necessary  to  commence  by  drying  up 
the  source  whence  it  flows ;  that  is  to  say,  the  excess  of  bile  and  vicious 
humors  engendered  by  the  liver.  Finally,  this  excess  of  humors  being 
due  to  an  impure  chyle  formed  in  the  stomach,  it  follows :  first,  that  we 
must  suppress  the  evident  causes  that  give  rise  to  the  formation  of  bad 
chyle,  in  other  words,  change  the  heating  diet ;  second,  purge  the  mass 
of  vicious  humors  arising  from  the  putrid  matter;  third,  evacuate 
this ;  fourth,  and  lastly,  suppress  the  excess  of  unnatural  heat,  if  it 
still  remains,  whether  in  the  liquids  or  solids. 

AVhat  a  chain  of  causes  to  follow,  and  how  many  indications  to  ful- 
fill in  the  cure  of  a  simple  fever !  What  would  it  be  when  one  had  to 
treat  a  somewhat  complex  disease,  or  a  complication  of  several  diseases  ? 
How  could  we  untangle  the  inextricable  interlacement  of  causes  inac- 
cessible to  observation  ?  To  return  to  the  example  cited  by  Fernel,  I 
will  ask,  by  what  kind  of  investigation  is  he  assured  that  the  symptoms 
of  a  simple  fever  are  due  to  that  series  of  intimate  causes  or  phenomena 

^  Method!  Medendi,  lib.  i,  cap.  iv. 


320  ERUDITE   PERIOD. 

which  he  paints  as  if  he  had  seen  them  ?  Did  he  follow  the  course  and 
development  of  these  phenomena  in  the  interior  of  the  living  economy, 
or  at  least,  did  he  find  the  incontestable  traces  of  them  on  the  cadaver  ? 
Not  at  all.  Some  ancient  physiologists  had  figured  to  themselves  that 
these  things  occurred  thus,  and  those  who  followed  them  were  contented 
with  this  explanation,  having  none  better  to  offer.  In  this  way  has  the 
doctrine  of  occult  causes  and  the  essence  of  things  been  sustained. 
This  doctrine  was  generally  admitted,  because  it  emanated  from  the 
reigning  philosophy,  as  we  have  already  shown,  and  because  it  flattered 
the  pride  of  the  human  mind.  Indeed,  it  seems  to  initiate  us  into  the 
most  intimate  mysteries  of  the  animal  economy ;  but  in  reality,  it  offers 
us  nothing  but  fictions. 

In  the  above  example  Fernel  considers  only  a  single  order  of  causes, 
while  in  his  pathology  he  admits,  truly,  a  frightful  number  of  them. 
There  are,  he  says,  according  to  the  philosophers,  four  sorts  of  causes, 
viz:  the  material,  the  formal,  the  efiicient,  and  the  final.  The  human 
body  is  the  material  cause  of  all  diseases ;  that  is  to  say,  the  subject  in 
which  our  diseases  necessarily  reside.  The  appearance  under  which  a 
morbid  afifection  presents  itself,  the  form  with  which  it  is  clothed  and 
which  determines  its  species,  is  its  formal  cause ;  the  end  towards  which 
it  tends  is  its  final  cause,  and  this  end  can  only  be  suffering  or  death. 
Finally,  the  efficient  cause  of  a  disease,  that  which  it  most  imports  the 
physician  to  understand,  is  nothing  else  than  the  force  which  modifies 
the  body  and  causes  it  to  pass  from  the  state  of  health  to  that  of  dis- 
ease. The  author  afterwards  divides  the  causes  in  several  other  ways, 
which  would  be  too  long  for  me  to  enumerate,  and  I  shall  only  report  the 
subdivisions  of  the  most  important  of  all — the  efficient  cause : 

1.  The  efficient  cause  is  divided  into  congenital  and  accidental. 

2.  The  congenital  is  either  natural  or  unnatural. 

3.  The  accidental  may  be  exterior  or  interior. 

4.  The  interior  accidental  is  divided  into  antecedent  and  continent. 

5.  The  efficient  cause  produces  its  effect  sometimes  immediately,  that 
is  to  say,  by  itself;  sometimes  in  a  consecutive  manner  or  by  accident. 

6.  Finally,  the  efficient  cause  is  divided  into  the  principal,  adjuvant 
and  indispensable.  For  example,  when  we  administer  a  drastic,  the 
principal  efficient  cause  of  the  purgation  is  the  purgative  virtue  of  the 
medicament ;  the  adjuvant  are  the  various  substances  that  are  added  to 
the  principal  medicament — the  preparation  to  which  it  is  submitted ;  the 
indispensable  is  only  the  natural  heat  of  the  body,  without  which  the 
virtue  of  the  remedy  is  inoperative." 

* PatliologiEe,  lib.  i.,  cap.  xi.  et  xn. 


INTERNAL  THERAPEUTICS.  321 

What  a  rigmarole !  Does  it  not  seem  as  if  they  had  undertaken  the  task 
of  surcharging  science  with  idle  considerations,  so  as  to  render  it  unintel- 
ligible and  ridiculous  ?  Unfortunate  were  those  patients,  who  fell  into 
the  hands  of  recent  graduates,  from  whose  minds  clinical  experience  had 
not  yet  removed  the  jargon  of  the  schools !  What  may  be  said  most 
favorable  of  the  physicians  of  those  times  is,  that  they  soon  unburdened 
themselves  in  the  presence  of  their  patients,  of  their  theoretic  baggage, 
and  contented  themselves  with  treating  each  case  of  disease  with  reme- 
dies that  had  succeeded  best  in  analogous  cases,  without  troubling  them- 
selves with  abstruse  questions  in  regard  to  their  pathogeny.  They 
reserved  this  pretended  scientific  lumber  for  the  official  dissertations  of 
the  schools  or  for  books.  In  short,  we  can  only  justify  the  medical  prac- 
tice of  past  ages  in  the  eyes  of  the  present  generation,  by  admitting  that 
these  physicians  followed,  in  their  treatment  of  diseases,  not  the  illusory 
indications  of  physiological  theories,  but  the  positive  facts  of  a  rational 
empiricism. 

Fernel  reduced  to  three  genera  all  methods  of  medication ;  namely : 
first,  evacuate  the  excedent  of  the  humors ;  second,  purge,  or  in  other 
words,  purify  the  humors ;  third,  alter,  that  is,  restore  to  the  normal 
state,  the  parts  which  have  been  vitiated  in  their  temperament  or  their 
composition.  He  examines  in  detail  the  efi'ects  of  each  of  these  plans  of 
treatment,  and  the  various  modes  of  instituting  them. 

ON   EVACUATING   MEDICATION. 

There  are  two  modes  of  evacuation,  says  Fernel,  the  one  general,  the 
other  particular.  The  first  mode  draws  the  humors  from  all  parts  of 
the  body,  as  the  sweat,  sanguineous  emissions,  vomitings,  and  alvine 
dejections.  Vomiting,  for  example,  discharges  first  the  stomach,  then 
the  larger  veins,  afterwards  the  veins  of  small  calibre,  finally,  the  whole 
body.  The  sanguine  emission  empties  at  first  the  veins  and  the  arteries, 
which  anastamose  with  them ;  lastly,  the  mass  of  the  body  and  the  vis- 
cera. Perspiration  evacuates  first  the  mass  of  the  body ;  next,  the  great 
veins  and  arteries ;  finally,  the  viscera  and  deep-seated  parts.'-- 

A  particular  evacuation  is  that  which  relates  to  a  special  region  or 
organ.  Thus,  the  excretions  of  the  nose  and  palate  relieve  the  brain 
only ;  cough  and  expectoration,  the  lungs  and  chest.  So  the  rectum  is 
relieved  by  a  hemorrhoidal  flux ;  the  uterus,  by  the  menses  ;  the  kidneys, 
by  the  sand  or  the  pus  mingled  with  the  urine ;  the  belly,  by  a  clyster 
or  a  supository ;  the  whole  superfices  of  the  body,  by  a  cutaneous  erup- 
tion.    An  artificial  issue  may  be  placed  in  any  region  whatever.f 


'•'  Method!  Medendi,  lib.  ii.,  cap.  ii.        f  Loc.  cit. 


322  ERUDITE   PERIOD. 

Of  all  artificial  evacuations,  that  of  phlebotomy  is  the  most  powerful, 
according  to  Femel,  because  it  withdraws  the  venous  blood,  which  con- 
tains the  four  principal  humors — the  bile,  pituite,  atrabile,  and  the 
pure  or  impure  blood.  It  is  applicable  in  all  cases  of  plethora,  either 
simple,  or  accompanied  by  cacochymy.  The  author  raises  apropos  to 
blood-letting,  the  following  questions:  What  are  the  immediate  and 
secondary  cfi"ects  of  blood-letting  ?  How  does  it  operate — by  revulsion, 
or  derivation?  What  are  the  diseases  which  claim  its  employment? 
Is  it  more  advantageous  before  or  after  the  invasion  ?  What  vein  is  it 
best  to  choose  in  a  given  case  ?  What  is  the  utility  of  a  spontaneous 
sanguineous  discharge  ?  What  are  the  indications  for  blood-letting,  and 
of  the  quantity  to  be  drawn  ?  At  what  period  of  the  disease,  or  on  what 
day,  and  at  what  hour,  is  it  best  to  practice  phlebotomy  ?  How  shall 
the  patient  be  prepared  for  it  ?  How  must  the  physician  act,  before  and 
after  the  operation  ? 

DEErVATION    AND   REVULSION. 

The  question  of  derivative  and  revulsive  bleedings  has  been  a  matter 
of  controversy,  for  a  long  time,  among  physicians,  but  it  has  lost  much 
of  its  interest  since  the  discovery  of  the  circulation  of  the  blood.  At 
this  time  the  words  derivation  and  revulsion  are  indifferently  employed, 
or  rather,  between  the  two  there  is  only  an  insignificant  shade  of  difier- 
ence.  The  veritable  demarkation  between  derivative  and  revulsive  blood- 
letting, says  M.  Guersant,  Sr.,  is  a  scholastic  subtilty,  which  originated,  at 
first,  among  the  Dogmatists,  who  departed  more  and  more  from  the  obser- 
vation of  nature.  A  little  further  on  he  adds,  "these  distinctions 
between  derivation  and  revulsion,  are  purely  systematic  and  abstract, 
and  do  not  rest  on  any  positive  differences.  We  cannot  even  admit  an 
essential  difference  between  words  which,  having  the  same  etymology, 
must  be  regarded  as  synonymous. "••'  The  ancients,  on  the  contrary, 
attached  to  these  words  very  distinct  significations,  founded  on  the 
errors  in  anatomical  and  physiological  science,  which  time  has  since 
corrected,  but  of  which  it  is  necessary  to  have  a  notion,  in  order  to 
conceive  of  the  importance  which  they  put  on  the  distinction  of  these 
two  things,  and  the  history  of  their  long  disputes  on  the  subject. 

Hippocrates  and  Galen  had  given  the  precept  to  bleed  largely  from 
the  arm,  on  the  diseased  side,  in  pleurisy  and  peripneumonia.  They 
directed,  even,  that  the  blood  be  permitted  to  flow  till  syncope  was  pro- 
duced. That  practice  was  gradually  abandoned,  when  the  sound  tra- 
ditions of  Greek  Medicine  began  to  be  lost  sight  of ;  finally,  the  Arabs 
substituted  for  it  one  entirely  opposite ;  they  prescribed  pricking  slightly 

*  Dictionnaire  de  Mcdecine,  in  21st  vol.,  at  the  word  Derivatiox. 


INTERNAL  THERAPEUTICS.  323 

the  vein  of  the  foot,  to  let  the  blood  flow  drop  by  drop.  Their  method 
prevailed  throughout  Europe,  until  the  commencement  of  the  sixteenth 
century  ;  then,  a  pleuritic  epidemic  having  appeared  several  times  in  the 
capital  of  France,  a  physician  of  Paris,  named  Pierre  Brissot,  distressed 
to  see  the  most  of  his  patients  perish,  and  encouraged  also  by  reading 
the  Greek  authors,  dared  to  revive  their  practice.  The  success  he 
obtained  filled  him  with  enthusiasm ;  he  hastened  to  publish  it,  and 
proclaimed  boldly  the  superiority  of  the  method  of  Hippocrates  to  that 
of  Avicenna.="= 

This  created  a  great  uproar  in  the  medical  world.  The  innovation 
found  partisans  and  adversaries,  equally  bitter.  The  dispute  grew 
warm ;  on  both  sides  learned  papers  appeared,  which  gave  no  new  light, 
and  persuaded  no  one.  The  Arabists  clamored  that  they  were  slan- 
dered, and  that  the  other  side  was  heretical,  so  that  but  little  was 
wanting  in  Spain,  to  invoke  the  auto-da-fe  for  the  defence  of  the  Arabic 
method.  Nevertheless,  the  contrary  method  triumphed,  less,  perhaps, 
because  clinical  observation  sustained  it,  than  because  the  fashion 
changed  from  Arabia  to  Greece.  However  this  may  have  been,  the 
question  was  nearly  settled  at  the  epoch  when  J.  Fernel  wrote ;  but  it 
was  not  extinct,  and  preserved  something  still  of  its  vitality.  On  this 
account  he  discusses  it  very  thoroughly,  and  conformably  to  the  ideas  of 
the  times.  I  will  now  give  the  substance  of  what  he  says  on  the  subject : 
"When  the  blood  makes  an  irruption  on  any  part,  the  promptest  means 
to  repress  its  impetuosity  consists  in  evacuating  it  in  an  opposite  direc- 
tion, from  the  most  distant  point  possible ;  in  other  words  we  must  ope- 
rate by  revulsion ;  for  the  most  natural  course  of  the  humors  is  in  a 
direct  line,  especially  in  the  veins,  whose  longitudinal  fibers  have  the 
property  of  attracting  the  liquids.  jSFow,  the  veins  of  all  the  right  side 
of  the  trunk  are  continued  into  the  right  arm,  and  the  veins  of  the  left 
side  into  the  left  arm.  Thus,  then,  in  pleurisy  and  pneumonia,  we  must 
open  the  vein  in  the  diseased  side,  as  taught  by  Hippocrates,  as  well  as 
by  reason.     In  hepatitis  the  bleeding  is  always  from  the  right  arm. 

It  is  not  the  same  for  the  pelvic  members ;  they,  being  in  direct  com- 
munication with  each  other  by  their  veins,  when  there  is  an  inflamma- 
tion in  the  right  leg,  the  revulsion  must  be  made  by  bleeding  in  the  left 
foot  and  vice  versa. 

Derivation  is  effected  by  attracting  the  humor  toward  a  point  near  the 
affected  part.     To  accomplish  it,  that  vein  is  opened  which  communicates 

•'  Apologia  qua  docetur  per  quae  loca  sanguis  mitti  clebeat  in  viscerum  inflam- 
mationibus,  praef.  in  pleuritide.     Paris,  1525,  4to. 


324  ERUDITE   PERIOD. 

with  the  point  itself,  and  we  thus  direct  to  the  orifice  sometimes 
the  nutritious  juice,  and  sometimes  the  bad  humor  that  keeps  up  the 
disease.  Then  the  excess  of  humor,  running  off  at  the  opening  estab- 
lished, relieves  very  much  the  diseased  part,  especially  if  care  be  taken, 
previously,  to  moderate  the  impetuosity  of  the  fluxion  by  a  revulsive 
bleeding.  But  if  the  engorgement  is  such  that  the  humor  can  no  longer 
flow,  which  happens  in  inveterate  inflammations  that  turn  into  scirrhus, 
derivation  must  be  attempted,  not  by  phlebotomy,  but  by  fomentations, 
emollient  plasters,  and  digestives.  ■■■= 

From  the  errors,  obscurity,  and  anatomical  nonsense  disseminated  in 
this  chapter  of  Fernel,  we  can  judge  that  the  question  of  revulsive  and 
derivative  bleedings  was  far  from  being  clear  at  an  epoch  when  it  was 
thought  to  have  been  entirely  resolved.  We  see  here,  also,  an  example 
of  the  facility  with  which  the  most  sagacious  minds  satisfied  themselves 
with  explanations  where  they  knew  absolutely  nothing. 

Fernel  speaks,  in  the  same  book,  of  the  efi'ects  of  local  blood-letting, 
which  is  effected  by  leeches  or  scarifications,  either  with  or  without  the 
aid  of  cups ;  he  explains,  also,  succinctly,  the  physiological  efi'ects  of  diet, 
exercise,  baths,  sweating-rooms,  anointings,  and  frictions ;  for  such  are 
the  means  which,  according  to  him,  evacuate  insensibly  all  the  humors 
of  the  body. 

II.    PUEGATIVE   MEDICATION. 

The  third  book  is  devoted  to  the  explanation  of  this  sort  of  medica- 
tion. Now,  we  know  that  by  purgative  medication  is  understood. all  the 
means  proper  to  provoke  the  evacuation  of  a  peccant  humor  through  any 
channel.  Thus,  vomits,  cathartics,  drastics,  sialagogues,  errhines,  ex- 
pectorants, etc.,  were  comprised  in  the  number  of  purgative  medica- 
ments. In  this  sense,  to  purge  signifies,  as  we  have  said,  to  purify  the 
economy — to  relieve  it  from  any  injurious  humor. 

We  can  conceive  how  much  importance  this  kind  of  treatment  had  in 
a  pathological  system,  where  nearly  all  diseases  were  supposed  to  origi- 
nate by  the  excess  or  vitiation  of  some  of  the  humors  of  the  body.  We 
are  not  astonished,  then,  that  our  therapeutist  speaks  of  it  with  so 
much  detail.  He  professes,  in  regard  to  this  class  of  remedies,  the 
opinion  of  Hippocrates  and  Galen,  who  assumed,  as  has  been  heretofore 
shown,  that  certain  substances  have  the  property  of  attracting  such  and 
such  humors :  some,  the  bile ;  others,  the  atrabile  ;  others,  the  phlegm, 
etc.  He  unfolds,  very  skillfully,  this  theory,  and  supports  it  by  argu- 
ments more  subtile  than  solid. 

■  Methodi  Medendi,  lib.  ii,  cap.  v. 


INTERNAL  THERAPEUTICS.  325 

III.    ALTERANT  MEDICATION. 

The  fourth  book  treats  of  alterant  medication ;  that  is,  of  a  medica- 
tion destined  to  modify  the  state  or  temperament  of  parts.  That  is 
termed  a  medicament,  says  our  author,  which  has  the  faculty  of  chang- 
ing the  natural  constitution  of  the  body  in  any  way  whatever.  Now, 
there  are,  in  medical  substances,  three  sorts  of  faculties,  which  are  con- 
sidered as  primitive,  secondary,  and  tertiary.  The  primitive  qualities 
depend  upon  the  preponderance  of  one  or  two  elements.  The  substances, 
for  example,  in  which  the  igneous  element  predominates  alone,  are  sim- 
ply hot ;  those  in  which  fire  and  moisture  exceed,  are  hot  and  humid, 
and  so  on.  These  primitive  qualities  constitute  what  was  formerly 
named  the  temperament  of  substances. 

The  secondary  qualities  result  from  the  union  of  the  primitive  quali- 
ties with  the  greater  or  less  density  of  substances.  In  regard  to 
density,  a  substance  may  be  tenuous  or  thin,  thick  or  gluey,  or  medium — 
that  is,  between  the  two  extremes.  The  combinations  of  various  de- 
grees of  density  with  the  temperament  or  primitive  qualities  of  sub- 
stances,  form  the  secondary  qualities,  of  which,  according  to  Fernel, 
the  following  are  the  chief:  the  incisive  or  attenuant  and  the  incras- 
sant,  detersive  and  inviscant  or  emplastic,  the  exasperative  and  demul- 
cent, the  aperient  and  obturative,  dilatant  and  constrictive,  rarcfiant  and 
condensing,  laxative  and  tonic  or  confortant,  the  attractive,  digestive, 
dissolvent,  repulsive,  emollient,  astringent,  maturative  or  supurative, 
septic,  agglutinative  and  exulcerant  or  vesicant,  sarcotic  and  corrod- 
ing, epulotic,  escarrotic  or  caustic. 

The  savory,  having  the  same  origin  as  the  secondary  qualities,  are  the 
best  indicators  for  these.  There  are  nine  sorts  of  this  kind  that  are 
distinguished  by  the  taste,  namely,  the  pungent,  the  acid,  the  greasy  or 
mucilaginous,  the  saline,  the  astringent,  the  sweet,  the  bitter,  the  acrid, 
and  the  insipid.  The  pungent  taste,  for  example,  which  is  remarkable  in 
pepper,  pillitory,  and  euphorbia,  indicate  the  tenuity  of  matter,  united 
to  a  dry  and  hot  temperament,  for  all  that  is  acrid  and  biting  partakes 
of  the  nature  of  fire.  Fernel  explains,  in  the  same  manner,  the  con- 
nections which  he  believes  to  exist  between  the  taste  of  the  above 
named  articles,  and  the  corresponding  secondary  qualities  ;  but  we  shall 
not  follow  him  in  the  details  of  this  more  curious  than  useful  theory. 

The  tertiary  qualities  of  medicaments  proceed  neither  from  the  tem- 
perament, nor  the  density  of  the  substance,  but  from  its  mass  and  form. 
For  this  reason,  these  qualities  are  denominated  the  occult  properties  of 
the  entire  substance.  Properties  of  this  class  are  not  manifested  either 
by  the  taste  or  any  sensible  quality,  but  by  experimenting.  Thus,  it  is 
by  experiment  alone,  that  certain  medicaments  are  ascertained  to  have 


226  ERUDITE   PERIOD. 

tlie  property  of  attracting  and  evacuating  from  the  body  a  particular 
liumor,  such  as  diuretics,  Vt'hich  provoke  the  emission  of  urine,  chola- 
gogues,  which  increase  the  flow  of  bile — hydragogues,  errhines,  emmena- 
gogues,  emetics,  drastics,  etc.  Others  neutralize  and  expel  animal  and 
vegetable  poisons,  such  as  alexiteric  or  alexipharmics.  These  various 
agents  produce  the  effects  that  we  have  just  enumerated,  in  virtue  of 
an  occult  principle,  depending  upon  their  substance  and  form,  which 
principle,  clinical  observation  only  can  reveal. 

If  we  wished  to  establish  a  species  of  comparison  between  antique 
and  modern  science,  we  could  say  that  the  primitive  qualities  of  the 
ancients  respond,  in  some  sort,  to  our  chemical  properties  ;  their  secon- 
dary qualities  to  our  physical  ones,  and  their  tertiary  to  our  specific 
medical  properties.  But  the  existence  of  most  of  the  primitive  and 
secondary  qualities  of  the  ancients,  is  purely  fictitious  and  nominal ; 
their  classification  is  confused,  their  origin  imaginary :  for  it  all  rests 
on  the  mental  analysis  of  the  philosophers,  and  not  on  an  experimental 
or  empirical  analysis,  like  that  of  our  modern  chemists. 

As  regards  the  faculties  which  are  named  tertiary,  they  have  generally 
more  reality,  and  their  denominations  have  been,  for  the  most  part,  pre- 
served in  medical  language ;  because  they  are  founded  on  clinical 
observation.  It  is  not  questionable  that  there  are  remedies  which 
excite  alvine  evacuations,  others  that  increase  the  flow  of  urine,  others 
that  excite  the  menstrual  flux,  others  the  saliva,  etc.  These  substances, 
it  is  true,  do  not  produce  their  effects  in  an  absolute  and  necessary  man- 
ner, but  only  under  given  circumstances,  that  is  to  say,  when  the  indi- 
vidual to  whom  they  are  administered  combines  certain  favorable 
conditions.  It  is  the  same  with  other  medicinal  properties ;  they  are 
nearly  all  conditional,  which,  however,  does  not  prevent  us  from  classing 
and  giving  them  names;  so  that,  whatever  may  be  the  phy so-pathologi- 
cal theories  in  vogue,  we  shall  always  have  substances  which  are  cathar- 
tics, diuretics,  emmenagogucs,  sialagogues,  errhines,  etc. 

The  ancients,  by  abstaining  from  giving  any  explanation  touching  the 
nature  and  origin  of  this  order  of  faculties,  and  by  saying  that  expe- 
rience alone  could  determine  them,  showed  themselves  more  than  usually 
wise  and  circumspect.  They  have  emitted,  on  this  point  in  the  science. 
a  reasonable  doctrine  which  no  scientific  revolution  has  yet  overturned. 
They  may  be  reproached  only  for  not  having  been  sufliciently  critical  in 
their  clinical  experiments — for  having  too  carelessly  attributed  to  a 
mass  of  substances,  admirable  virtues,  which  the  observations  of  succeed- 
ing ages  have  not  confirmed  :  so  that,  before  inscribing  in  their  formu- 
laries that  a  given  substance  was  endowed  of  certain  properties,  they 
should  have  submitted  it  to  repeated  and  varied  experiments — they 


I 


INTERNAL  THERAPEUTICS.  327 

should  have,  in  a  word,  conformed  themselves  to  the  excellent  precepts 
given  by  the  Empirical  physicians  of  the  school  at  Alexandria. 

Fernel  shows,  in  the  same  hook,  the  reasons  which  may  justify,  in  many 
cases,  the  employment  of  compound  remedies,  and  he  lays  down  the  rules 
which  must  be  observed  in  the  process  of  mingling  various  substances. 
He  enumerates  the  pharmaceutical  and  magisterial  forms,  in  which  they 
were  accustomed  to  administer  medicaments,  as  well  as  the  particular 
advantages  attached  to  each  of  these  forms.  He  speaks,  among  other 
preparations  of  distilled  waters,  essential  oils,  infusions,  decoctions, 
extracts,  syrups,  powders,  conserves — in  short,  of  nearly  all  the  prepara- 
tions now  used  in  pharmacy  and  medicine.  The  last  three  books  of  the 
same  work,  namely,  the  fifth,  sixth,  and  seventh,  embrace  materia 
medica  proper,  and  a  small  formulary.  The  medicamental  substances 
are  there  classed  according  to  their  mode  of  action  on  the  animal 
economy,  that  is,  according  to  the  physiological  effects  they  produce  in 
the  organism.  This  basis  of  classification  would  have  been  excellent, 
if  the  action  of  remedies  had  been  established  on  careful  clinical  obser- 
vation ;  but  we  have  seen  that  of  the  three  orders  of  faculties,  the  first 
two  were  imaginary  or  hypothetical,  and  the  third  only  was  founded  on 
medical  observation.  Unhappily,  yet,  the  observations  which  had 
served  to  establish  the  third  class  of  faculties  were  not  always  made 
with  proper  care.  Thus,  therefore,  among  the  virtues  attributed  to 
medicamental  substances  in  the  ancient  formularies,  the  greater  part 
should  be  regarded  as  hypothetical,  exaggerated,  or  false. 

The  judicious  Ternel  had  well  felt  this  defect,  and  he  alludes  to  it  in 
the  preface  of  his  fifth  book,  where  he  says  that  he  will  admit  into  his 
materia  medica  only  such  substances  as  are  well  proved  by  long  expe- 
rience ;  preferring  a  small  number  of  well  known  and  well  studied 
remedies,  to  a  great  number  of  doubtful  ones.  Nevertheless,  he  assigns 
to  many  of  the  substances,  properties  which  are  entirely  imaginary  ; 
because,  to  avoid  this  defect,  he  would  have  found  it  necessary  to  have 
reconstructed  science,  which  is  the  work  of  ages,  and  not  of  one  man 
alone.  He  does  not  mention  some  substances  from  the  mineral  king- 
dom, newly  introduced  into  medicine,  such  as  certain  salts  of  antimony, 
mercury,  gold  and  copper.  The  effects  of  these  energetic  agents,  which 
now  render  such  signal  service  in  medicine,  were  at  that  time  but  little 
known.  They  were  scarcely  employed,  except  in  the  hands  of  charlatans, 
barbers  and  alchymists,  who  administered  them,  right  or  wrong,  without 
precise  indications  or  in  proper  doses,  so  that  their  use  did  more  harm 
than  good.  We  must,  then,  approve  the  circumspection  of  Fernel, 
which  led  him  to  exclude  from  his  formulary  these  powerful  remedies, 
yet  too  little  tested,  when  we  reflect  that  he  was  placed  at  the  head  of 


328  ERUDITE   PERIOD. 

medical  teaching — that  his  book,  destined  for  the  instruction  of  young 
men,  became  classic  throughout  Europe,  from  its  first  appearance — and 
that  these  heroic  remedies,  which  may  be  employed  by  a  skillful  hand 
without  danger,  produced,  at  that  epoch,  effects  nearly  as  formidable  as 
those  of  the  disease  against  which  they  were  administered,  as  the  result 
of  the  ignorance  and  temerity  of  the  medicasters  who  proclaimed  them 
to  be  panaceas. 


CHAPTEK     VII. 
EXTERNAL   PATHOLOGY  AND   THERAPEUTICS. 

In  all  time,  external  pathology  and  therapeutics  have  surpassed  in 
progress,  the  career  of  internal  pathology  and  therapeutics.  It  is  a  law 
that  holds  to  the  nature  of  things.  External  diseases  are  more  easily 
discerned  than  internal ;  they  may  be  better  observed  from  the  com- 
mencement, with  their  progress,  phases,  and  various  modifications.  The 
remedies  can  be  applied  immediately  to  the  parts  affected,  and  their 
effects  be  observed  with  exactness.  All  these  advantages  in  favor  of 
surgery  render  it  more  permanent  than  Medicine,  so  that  its  progress 
is  more  constant  and  certain. 

Nevertheless,  this  law  appears  inverted  during  the  middle  ages.  In 
the  midst  of  the  general  decadence  of  the  sciences  in  Europe,  surgery 
fell  yet  lower  than  medicine,  for  the  reason  that  the  latter  was  in  the 
hands  of  the  priests,  the  only  men  who  had,  at  that  time,  a  tincture  of 
a  liberal  education  ;  while  the  practice  of  surgery  was  abandoned  to  a 
class  of  ignorant  barbers,  bathers  and  bone-setters.  I  will  mention 
one  fact,  which  will  give  some  idea  of  the  extreme  contempt  in  which 
this  class  of  operators  was  held.  "  No  artisan,"  says  Sprengel,  "  could 
take  a  young  man  as  an  apprentice,  without  an  attestation  showing  that 
he  was  born  of  honest  parents,  the  fruit  of  a  legitimate  marriage,  and 
the  issue  of  a  family  in  which  there  were  neither  barbers,  bath-keepers, 
shepherds  nor  butchers;  nevertheless,"  says  this  historian,  "  these  men 
were,  to  the  middle  of  the  fifteenth  century,  the  surgeons  of  most  of  the 
cities  in  Germany.  The  other  countries  of  Europe  were  but  little  more 
advanced  than  Germany,  with  the  exception  of  Italy,  where,  as  we  have 
seen,  from  the  thirteenth  and  fourteenth  centuries,  several  physicians  did 
not  disdain,  entirely,  surgical  operations ;  and  France,  where  Lan- 
franc  and  Guy  de  Chauliac  gave  it  a  temporary  eclat  towards  the  close 
of   the   Arabic  period.     But   these  rare   exceptions   did   not  prevent 


EXTERNAL  THERAPEUTIS.  329 

surgery  in  France,  and  even  in  Italy,  as  in  Germany  and  the  rest  of 
Europe,  from  being  abandoned  completely  by  the  clergy,  who  devoted 
themselves  to  the  practice  of  Medicine. 

If  it  be  now  asked  how  it  was  that  an  art  as  useful  as  the  surgeon's — 
the  practice  of  which  requires  extended  and  various  knowledge,  as  well 
as  sagacity,  courage  and  address — an  art,  the  necessity  of  which  must 
have  been  so  frequently  felt  in  those  calamitous  times  of  continual  war  and 
combat,  and  the  services  of  which  are  so  much  more  manifest  than 
those  of  internal  therapeutics — was  so  neglected  by  men  who  could 
best  comprehend  its  utility,  namely,  the  doctors  in  medicine,  the  re- 
sponse is  easy,  and  our  readers  can  make  it  themselves,  by  recalling 
what  we  have  said  of  the  constitution  of  society  in  general,  and  the 
medical  profession  in  particular,  during  the  middle  ages.  The  Chris- 
tian nations  of  the  West  were  at  that  time  divided  into  three  very  dis- 
tinct orders,  namely :  the  noblesse,  unceasingly  at  war  ;  the  clergy, 
filling  all  the  liberal  professions ;  the  populace,  in  all  the  lowest  occu- 
pations, supporting  all  the  rest,  but  having  no  privileges.  In  this 
division,  the  practice  of  the  Healing  Art  was  a  clerical  right ;  but,  as 
we  have  before  observed,  a  canon  of  the  Church  prohibited  them  from 
drawing  blood,  under  pain  of  excommunication ;  consequently  the  most 
of  them  abandoned  the  practice  of  surgery  to  the  ignorant  and  vulgar 
laity,  who  acquitted  themselves  in  it  as  a  pure  mechanical  work,  without 
any  idea  of  the  art  or  its  progress. 

Another  reason,  no  less  powerful,  also  removed  the  clerical  doctors 
from  the  practice  of  surgery ;  it  was  the  lack  of  all  detailed  and  precise 
anatomical  notions,  which  are  as  indispensable  to  the  physician  as  the 
surgeon,  but  the  defect  of  which  is  more  sensible  and  opprobrious  in  the 
latter.  The  absence  of  anatomical  knowledge  was,  it  is  true,  common  to 
both  the  clerical  doctor  and  lay  operator,  but  the  latter,  being  less  en- 
lightened, did  not  feel  so  much  its  need ;  being  also  less  elevated  in  the 
social  hierarchy,  he  had  less  fear  of  compromising  himself.  Moreover, 
a  great  number  of  the  operators  had  no  fixed  residence ;  they  went  fr^m 
city  to  city,  and  stopped  in  each  place  as  long  as  they  had  any  cases 
submitted  to  them,  or  until  some  reverses  forced  them  to  depart.  The 
most  of  them  limited  themselves  to  one  or  two  sorts  of  operations ;  some 
operated  for  cataract,  others  for  stone,  others  for  hernia,  etc.,  according 
to  methods  which  they  kept  secret,  and  which  they  transmitted  to  their 
children  as  an  heritage.  The  History  of  Medicine  has  preserved  the 
names  of  some  of  those  families  of  itinerant  operators,  such  as  the 
Branca,  the  Norsini  in  Italy,  and  the  Colot  in  France. 

In  hands  so  unskillful  the  art  could  not  grow,  and  the  profession  must 
be  mean.  Neither  began  to  revive  until  the  prejudice  which  opposed 
21 


330  ERUDITE   PERIOD. 

anatomical  dissections,  and  which  prevented  physicians  from  practis- 
ing surgeiy,  began  to  abate.  But  this  revolution  was  effected  very 
slowly.  The  dawn  of  it  began  from  the  thirteenth  to  the  fourteenth 
centuries,  during  which  a  very  few  of  the  clergy  dared,  in  a  timid  man- 
ner, to  perform  surgical  operations.  The  number  increased  in  the  course 
of  the  fifteenth  century,  and  at  last  became  considerable,  in  the  sixteenth. 
The  most  of  the  great  anatomists  of  that  period  were  at  the  same  time 
distinguished  surgeons,  such  as  Benivieni,  Berenger  de  Carpi,  Vesalius, 
Fallopius,  Fabricius  d'Aquapendente,  and  others. 

While  the  clerical  physicians  were  willing  to  descend  to  the  rank  of 
operators,  the  lay  surgeons  aspired  to  the  level  of  doctors  in  medicine. 
This  latter  transformation  took  place  especially  in  France,  the  only 
country  where  at  that  epoch  there  existed  a  special  college  of  surgeons. 
This  college  was  no  other  than  the  small  brotherhood  of  St.  Come,  which, 
always  contending  against  the  faculty  on  one  hand,  and  the  barber-sur- 
geons on  the  other,  sometimes  defeated,  sometimes  triumphant,  but  never 
submissive,  asked  at  last  a  peace  with  the  university,  and  was  benignly 
received  by  it  among  the  number  of  its  scholars,  and  enjoyed  thereafter 
without  molestation  the  privileges  and  immunities  attached  to  this  title. 
This  took  place  in  1515.  "From  that  moment,"  says  M.  Malgaigne, 
"  a  new  state  of  things  commenced  for  surgery  in  Paris.  The  Faculty 
reigned  over  the  surgeons  and  barbers,  who  were  admitted  together  to  their 
lectures.  The  barbers  followed  the  course  on  anatomy  and  surgery,  which 
gradually  drew  them  nearer  to  the  surgeons  of  St.  Come,  and  prepared 
them  to  wear  worthily  their  new  title  of  barber-surgeons.  But  they  did 
not  obtain  these  unexpected  results  without  giving  up  some  of  their 
former  rights.  Thus,  besides  their  initiation  by  a  proper  tribunal,  to 
the  privilege  of  barbering,  they  had  to  pass  an  examination  before  the 
physician  and  the  two  surgeons  of  the  king,  at  Chatelet,  for  the  right  to 
practice  surgery.  The  surgeons,  as  the  price  of  their  submission  to  the 
faculty,  had,  then,  besides  the  university  privileges,  acquired  a  sort  of 
supremacy  over  the  barbers  ;  also,  their  daily  association  in  study  and 
hierarchy,  dissipating  the  memory  of  old  divisions,  prepared  for  the 
new  epoch  results  which  perhaps  never  before  took  place ;  the  barbers 
were  admitted  to  the  rank  of  surgeons  of  St.  Come,  and  the  surgeons 
of  St.  Come  were  admitted  as  doctors  regents  of  the  Faculty  of 
Medicine." 

Thus  surgery  offers  during  this  period  a  double  upward  movement , 
on  one  hand  it  approaches  as  a  profession  medicine  proper,  from  which 
it  should  never  have  been  separated ;  on  the  other,  it  received  as  an  art 

''Introduction  to  the  works  of  A.  Pare,  1. 1.,  p.  153. 


EXTERNAL  THERAPEUTICS.  331 

numerous  improvements.  Among  the  men  who  contributed  to  extend 
it,  we  have  already  cited  the  names  of  some  celebrated  anatomists ;  to 
these  we  will  add  those  of  John  de  Vigo,  Fabricius  of  Hiklen,  Maggi 
Peter  Franco,  Felix  Wurtz,  Jacques  Guillemeau,  and  above  all,  that  of 
Ambrose  Pare,  who  from  a  sim^^le  journeyman  barber,  elevated  himself 
by  obstinate  labor  and  his  genius  to  the  rank  of  the  first  surgeon  of  his 
age. 

The  life  of  Ambrose  Pare  is  so  closely  related  to  the  progress  of  sur- 
gery during  that  epoch,  that  by  tracing  it  we  give,  in  some  sort,  the 
history  of  its  progress.  On  this  account  I  do  not  think  I  am  leaving 
my  subject,  by  extracting  from  his  biography  the  passages  which  con- 
nect him  most  directly  to  the  history  of  the  art  itself.  Ambrose,  born 
at  Laval,  of  parents  not  in  easy  circumstances,  did  not  receive  a  univer- 
sity education,  having  never  learned  the  Latin,  the  only  language  at  that 
time  in  the  books  and  schools  of  Medicine.  The  date  of  his  birth,  though 
uncertain,  must  have  been  between  the  years  1510  and  1517.  His  first 
apprenticeship  was  to  a  provincial  barber- surgeon,  after  which  the  desire 
for  improvement  led  him  to  Paris,  about  the  year  1532  or  1533.  He 
studied  for  three  years  at  the  Hotel  Dieu  in  that  city,  and  it  appears 
that  he  obtained  so  fully  the  confidence  of  his  masters,  that  they  some- 
times made  him  perform  their  operations.  Pare  loved  to  recall  his 
sojourn  in  that  hospital;  he  counted  it  among  his  highest  honors,  which 
permits  us  to  presume  that  these  functions  were  coincident  only  with 
important  duties,  and  even  not  a  common  right  nor  an  ordinary  favor. 
"  Be  it  known,"  he  says  in  his  Preface,  to  the  reader,  "  that  for  the  space  of 
three  years  I  resided  at  the  Hotel  Dieu  of  Paris,  where  I  had  an  oppor- 
tunity to  see  and  know  (owing  to  the  great  diversity  of  patients  goino- 
there)  everything  that  concerns  operations  and  diseases  pertaining  to  the 
human  body ;  and  besides,  I  learned  there,  on  an  infinite  number  of 
bodies,  all  that  can  be  said  and  considered  on  anatomy ;  also,  that  often 
I  made  very  satisfactory  proofs  of  it,  and  that  very  publicly,  in  Paris  at 
the  schools  of  medicine."  And  in  his  Apology,  when  a  physician  of 
Milan  seemed  astonished  at  the  young  man's  knowledge,  he  remarked, 
not  without  some  pride,  ''But  tlie  good  man  did  not  know  that  I  had 
been  house-surgeon  for  three  years  at  the  Hotel  Dieu  of  Paris."  •- 

In  regard  to  the  functions  of  these  barber  apprentices  in  the  hospitals, 
and  the  kind  of  instruction  they  received  there,  we  have  no  positive 
knowledge,  but  it  is  probable  that  they  made  the  dressings,  bleedings 
and  post  mortems  ordered  by  the  master  surgeon — that  they  assisted  him 
in  his  operations,  and  perhaps  took  his  place  in  cases  of  urgency,  about 


'Introduction  to  the  works  of  A.  Pare,  t.  I.,  p.  232. 


332  ERUDITE   PERIOD. 

as  commonly  as  the  Internes  do  in  our  hospitals  at  present.  They 
learned  by  watching  the  operations  of  their  chief — by  listening  when 
they  deigned  to  converse  with  them,  and  by  carefully  studying  the  pa- 
tients. They  found  there,  also,  opportunities,  precious  and  rare  at  that 
time,  for  anatomical  dissection  ;  but  it  does  not  appear  that  they  had 
any  regular  instructions  in  clinics — the  communications  between  the 
master  and  his  pupils  being  optional,  depending  absolutely  on  the  plea- 
sure of  the  former. 

It  was  not  long  after  his  leaving  the  Hotel  Dieu,  in  the  year  1536,  that 
Ambrose  made  his  first  campaign.  He  held  the  position  of  surgeon  to 
the  Marshall  de  Monte-Jan,  colonel-general  of  the  French  infantry,  of 
the  army  which  Francis  I.  assembled  in  Provence  to  repulse  the  invasion 
of  Charles  Y.  "  He  had  never  seen  war,  nor  recent  gun-shot  wounds, 
and  only  knew  of  them  by  what  he  had  read  in  John  de  Vigo.  1  shall 
not  repeat  what  he  has  so  well  recounted  himself;  it  should  be  read  both 
in  his  first  discourse,  in  the  book  on  Arquebuse  Wounds,  and  in  his  great 
apology,  how,  after  the  aflfair  of  the  Pas-de-Suze,  he  watched  the  other 
surgeons,  dreaming  of  nothing  else  but  to  imitate  them  as  far  as  he 
could  ;  how  the  boiling  oil  giving  out,  with  which  all  wounds  were  cau- 
terised, anxiety  about  it  prevented  him  from  sleeping  soundly,  and  how, 
to  his  great  admiration,  he  found  that  the  wounded  who  had  been  sub- 
mitted to  the  operation,  suficred  more  than  the  others.  This  accident 
put  him  in  the  way  of  his  first  discovery  :  but  the  rap/idity  and  depth 
of  his  judgment,  and  the  boldness  of  resolution  which  led  him,  a  young 
man,  without  name  or  authority,  and  moreover,  without  letters  or  philo- 
sophical studies,  at  once  to  observe,  to  point  out,  and  combat  a  doctrine 
universally  admitted  and  sustained  by  the  highest  surgical  renown  of 
the  epoch,  was  not  an  accident." 

The  earliest  authors  who  had  spoken  of  gun-shot  wounds,  considered 
them  as  poisoned,  and  complicated  with  burning.  Consecjuently,  they 
gave  the  precept  to  cauterise  them  with  boiling  oil,  or  red  hot  iron,  and 
administer  internally  at  the  same  time  alexipharmics,  for  the  purpose  of 
arresting  the  progress  of  the  poison.  John  de  Vigo,  who  was  physician 
of  Pope  Julius  II.,  assures  us  that  the  danger  of  these  wounds  results 
from  the  round  form  of  the  balls,  their  degree  of  heat,  and  the  poison- 
ous qualities  that  the  powder  communicates  to  them.  His  theory,  and 
the  method,  doubly  incendiary,  which  was  its  necessary  consequence, 
had  been  adopted  without  contradiction,  till  the  day  that  Ambrose  Pare 
dared  protest  against  them. 

After  a  campaign  of  three  years,  having  lost  his  master,  he  returned 
to  Paris,  where  he  married  the  daughter  of  the  valet-chaufFe-cire  of  the 
Chancery  of  France.  In  15-13,  we  find  him  with  the  army  of  Perpignan, 


i 


EXTERNAL  THERAPEUTICS.  333 

ia  the  service  of  M.  de  Eohan,  grand  lord  of  Brittany,  and  lie  gave 
proofs  there,  on  several  occasions,  of  his  sagacity.  "  I  presume,"  con- 
tinues M.  Malgaigne,  "  it  was  after  this  campaign  that  his  reputation, 
so  well  established  among  wan-iors  and  great  lords,  inspired  Sylvius 
with  the  desire  of  seeing  him.  In  fact.  Pare  recounts  that  in  the  con- 
versation they  had  together,  he  insisted  on  the  special  and  entirely  new 
precept,  of  which  he  made  so  happy  an  application  on  M.  Brissas,  that 
of  placing  the  wounded  in  order  to  extract  balls,  in  the  position  they 
were  at  the  moment  they  were  shot.  This  interview  was  honorable  in 
all  respects  to  both.  Sylvius,  whose  teachings  attracted  more  auditors 
than  those  of  Fernel,  even  invited  the  young  surgeon  to  dinner,  and 
heard,  with  great  attention,  the  observations  and  experiments  on  which 
Pare  had  established  his  doctrines  on  gun-shot  wounds,  and  was  so  much 
struck  with  them,  that  he  besought  him  with  great  warmth,  to  write 
them  out,  and  make  them  public.  Pare  felt,  sensibly,  this  encourage- 
ment coming  from  so  high  a  source,  and  prepared  his  text,  drew  the 
figures,  and  in  the  year  1545,  at  Vivant  Gaulterot's,  sworn  bookseller  in 
the  University  of  Paris,  that  little  work,  which  mai'ked  in  a  manner  so 
glorious  the  revival  of  French  Surgery  was  published,  with  the  following 
title:  The  Manner  of  Treating  Wounds  made  hy  Arquebuses  and  other 
Fire  Arms,  and  those  made  by  Arrows,  Darts,  and  the  like  ;  and  also  of 
Burns  made  especially  by  gunpowder :  Composed  by  Ambrose  Pare. 
Master  barber- Surgeon,  Paris.'--' 

"In  a  few  months  Pare  published  his  second  edition,  in  which  he 
recommends  still,  the  actual  cautery  in  hemorrhage ;  but  each  day 
he  made  it  a  subject  of  meditation,  and  on  one  occasion  he  discussed 
the  subject  with  Stephen  de  la  Pdviere  and  Francis  Basse,  both  surgeons 
of  Saint-Come,  and  submitted  to  them  the  idea,  so  simple  and  so  lumi- 
nous, that  since  ligatures  were  applied  to  veins  and  arteries  in  recsnt 
wounds,  there  was  nothing  to  prevent  their  being  equally  applied  after 
amputation.  Both  agreed  with  him,  and  he  only  needed  the  opportunity, 
which  soon  presented  itself  at  the  siege"'of  Damvilliers.  A  gentleman 
of  M.  de  Eohan  had  his  leg  crushed  by  a  shot  from  the  fortress.  Pare 
made  an  amputation,  and  for  the  first  time  did  not  apply  the  cautery. 
He  had  the  happiness  to  save  his  patient,  who,  full  of  joy  at  having 
escaped  the  red-hot  iron,  said  that  he  had  got  clear  of  his  leg  on  very 
good  terms.  This  last  discovery  was  not  less  fortunate  than  the  former. 
of  which  it  was,  if  I  may  say  so,  the  complement.  By  the  first  step 
the  young  surgeon  saved  from  cauterization  all  who  had  simple  gun-shot 
wounds ;  by  the  second,  he  spared  all  subjects  of  amputation  dreadful 

^  Introduction  to  the  works  of  A.  Pare,  p-  236. 


334  ERUDITE   PERIOD- 

suffering.  Military  surgery,  -whicli  till  that  time  had  been  a  torture, 
became  a  blessed  art,  and  it  was  a  barber-surgeon  who  produced  the 
double  marvel."  =•' 

This  took  place  in  1552.  In  the  month  of  October,  in  the  same 
year,  one  of  the  most  eminent  of  the  generals  of  Charles  V.  having 
besieged  Metz,  the  Emperor  came  in  person  to  join  the  army,  on  the 
twentieth  of  the  following  month.  "  The  city,  defended  by  the  Duke 
de  Guise,  with  seven  princes  under  his  orders,  and  a  number  of  gentle- 
men, had  to  suffer  at  the  same  time  the  attacks  of  the  enemy,  the 
fatigues  of  the  siege,  and  the  rigors  of  a  frightful  winter.  The  Duke 
had  established  two  hospitals  for  the  soldiers.  He  had  put  in  requi- 
sition the  barber-surgeons  of  the  city,  and  had  even  advanced  to  them 
the  money  to  get  supplies  of  ointments  and  drugs ;  but  the  ignorance 
of  the  surgeons  unfitted  them  to  struggle  against  a  combination  of  cir- 
cumstances so  unfavorable,  and  nearly  all  the  wounded  perished,  which 
caused  a  suspicion  among  the  troops  that  they  were  poisoned.  The 
Duke  de  Guise  dispatched  one  of  his  captains,  named  Thomas  Delveche, 
to  the  king,  to  say,  that  the  place  could  hold  out  for  ten  months,  but 
asked,  at  the  same  time,  for  fresh  medicines.  The  king  sent  for  Pare, 
handed  him  one  hundred  crowns,  and  directed  him  to  take  all  the 
medicine  he  thought  necessary,  and  gave  him  also  a  letter  to  Marshal 
St.  Andre,  who  commanded  in  Yerduu.  The  Marshal  and  M.  de 
Vieille-Yille  bribed  an  Italian  captain,  who  engaged,  for  fifteen  hundred 
crowns,  to  introduce  into  the  besieged  city,  A.  Pare,  his  valet,  or  his 
man,  and  the  captain  of  the  Duke  de  Guise.  The  expedition  was 
perilous,  and,  to  tell  the  truth,  says  our  naive  author,  he  would  very 
willingly  have  remained  in  Paris.  He  passed,  however,  without  acci- 
dent, and  the  little  caravan  entered  Metz  the  eighth  of  December,  at 
midnight,  by  the  Moselle  gate.  He  was  known  to  the  chiefs  and 
common  soldiers,  for  he  had  already  passed  sixteen  years  in  war,  and 
enjoyed  the  highest  renown  in  military  surgery.  The  next  day  after 
his  arrival,  the  cluke,  who  knew  how  to  strike  the  imagination,  presented 
him  on  the  rampart  to  all  the  princes,  lords,  and  captains,  who  embraced 
and  received  him  with  acclamations.  On  the  same  day  he  began  to 
treat  the  leg  of  M.  de  Magnane,  who  for  four  days  had  been  in  charge 
of  a  charlatan,  and  had  suffered  horrible  tortures.  The  next  day  he 
decided  to  trephine  M.  de  Bugueno,  who  had  been  struck  by  a  fragment 
of  stone  on  the  head,  and  had  laid  insensible  for  fourteen  days.  He 
cured  them  both.  His  success,  which  the  surgery  of  our  period  must 
pronounce  extraordinary,  appears  to  me  as  a  strong  testimony  of  the 

^°  Introduction  to  the  works  of  Ambrose  Pare. 


EXTERNAL  THEEAPEUTICS.  335 

confidence  "witli  which  Pare  inspired  the  wounded,  and  which  facilitates 
such  cures." 

The  little  brotherhood  of  Surgeons  of  St.  Come,  recently  erected  into 
a  college,  ready  to  seize  on  every  circumstance  which  could  redound  to 
their  advantage,  desiring  to  possess  in  its  community  a  man  who  enjoyed 
such  great  renown,  and  of  such  high  standing  at  the  Court,  decided  to 
admit  him  to  an  examination,  in  despite  of  the  statute  which  required 
that  the  candidate  should  understand  Latin ;  and  besides,  what  was 
unheard  of  before,  they  awarded  him  the  honor  of  a  gratuitous  recep- 
tion. In  the  course  of  the  year  1554,  Ambrose  Pare  submitted  to  all 
the  examinations,  and  obtained  successively  the  grades  of  bachelor, 
licentiate,  and  master  in  surgery. 

Notwithstanding  the  correctness  and  firmness  of  his  character,  of 
which  he  gave  a  thousand  proofs,  his  favor  at  the  Court  never  dimin- 
ished. He  was  surgeon  in  ordinary  to  Henry  II.,  and  Francis  II.,  first 
surgeon  of  Charles  IX.,  and  of  Henry  III.,  which  caused  the  witty  and 
true  remark,  that  the  kings  of  France  transmitted  him  to  their  succes- 
sors as  a  legacy  of  the  crown.  In  the  midst  of  the  excitement  of 
camps,  and  a  very  extended  private  practice,  he  found  time  to  read  all 
that  had  been  published  on  his  Art,  and  to  compose  a  great  number  of 
works  himself.  He  enriched  nearly  all  the  branches  of  surgery  with 
some  discovery  or  improvement ;  but  instead  of  making  a  secret  of  his 
inventions,  as  was  very  much  the  custom  at  that  time,  he  thougbt  it  his 
conscientious  duty  to  give  the  public  the  benefit  of  them.  "  For  my 
part,"  he  says,  in  the  preface  of  his  large  work  on  Surgery,  "I  have 
dispensed  liberally  to  every  body  the  gifts  that  God  has  conferred  upon 
me,  and  I  am  none  the  worse  for  it,  just  as  the  light  of  the  candle  does 
not  diminish,  however  many  may  come  to  light  their  torches  by  it." 

The  doctrine  of  A.  Pare,  on  gun-shot  wounds,  was  rapidly  dissemina- 
ted. From  the  year  1550  Bartholomew  Maggi,  a  physician  of  Bologna, 
advocated  it  without  naming  its  author,  and  sustained  it  by  decisive 
experiments.  He  observed  that  none  of  the  wounded  by  arqucbuse  shots 
felt  any  heat,  and  that  their  clothing  did  not  present  any  trace  of  burn- 
ing. He  shot  balls  through  packets  of  powder,  without  setting  them  on 
fire.  John  Lange  made  these  views  known  in  Germany.  Leonard  Botal, 
a  celebrated  physician  of  Turin,  was  also  one  of  the  first  to  take  it  up, 
but  like  those  I  have  named,  kept  back  the  true  author's  name."'-' 

I  have  dwelt  somewhat  at  length  on  the  theory  and  the  treatment  of 
gun-shot  wounds,  because  this  class  of  lesions,  unknown  to  the  ancients, 
had  at  that  time  acquired  a  major  importance,  to  increase  from  day  to 

"'  (Euvres  d'  A.  Pare. 


336  ERUDITE   PERIOD. 

day,  as  a  result  of  the  incessant  employment  of  t^iat  species  of  weapon. 
I  shall  not  enter  into  a  detail  of  the  additions  and  improvements  that 
the  other  branches  of  surgery  received  at  that  epoch  ;  these  details  will 
be  more  in  place  in  the  following  period,  when  we  shall  give  a  retrospec- 
tive glance  at  the  history  of  each  of  the  principal  surgical  operations. 

Obstetetcs. 

I  have  already  said,  but  it  may  not  be  improper  to  repeat  it,  that 
obstetrics  is  a  branch  o."  surgery  which,  from  its  importance,  merits  to  be 
examined  separately ;  there,  as  before  observed,  the  life  of  two  individuals 
depends  on  a  skillful  maneuver,  or  on  an  indication  clearly  understood. 
The  great  surgeons  of  the  sixteenth  century  felt  this  truth,  and  did  not 
neglect  the  art  of  accouchement ;  but  none  of  them  occupied  themselves 
with  it  in  so  special  a  manner  as  Jacob  Guillemeau,  pupil  and  friend  of 
Ambrose  Pare.  We  owe  to  him  the  first  improvements  that  the  moderns 
made  in  this  art.  I  will  cite,  as  one  of  the  most  capital,  the  formal  pre- 
cept, to  terminate  the  accouchement  artificially,  in  the  case  of  consider- 
able hemorrhage,  or  when  the  woman  is  taken  with  convulsions,  during 
labor.  Guillemeau  supports  the  precept  on  the  authority  of  Hippocrates, 
and  what  is  much  better,  on  a  great  number  of  facts  which  prove  the 
value  of  the  practice,  and  how  great  the  danger  of  its  neglect,  when  it 
is  indicated. 

The  Cesarian  operation  was  known  to  the  ancient  Greeks  and  Eomans, 
but  during  the  middle  ages,  like  many  others,  it  had  been  abandoned. 
Some  of  the  surgeons  of  the  sixteenth  century  attempted  to  re-establish 
it ;  among  others  Francis  Eousset,  physician  to  the  duke  of  Savoy,  who 
recommends  it  very  warmly.  He  reports  several  cases,  where  it  had  a 
happy  issue,  both  for  the  mother  and  the  child.  The  most  remarkable 
of  all  is  that  of  a  woman  of  Milly,  who  was  delivered  six  times  by  this 
operation,  and  perished  in  her  seventh  confinement,  because,  according 
to  Eousset,  the  surgeon  who  had  been  accustomed  to  operate  upon  her 
was  absent.     Unhappily,  these  facts  are  not  well  established. 


CHAPTEE    VIII. 

CLINICS. 

Clinics,  as  has  been  said,  is  not  a  branch  of  medical  science :  it  is 
the  science  in  totality,  taught  or  put  in  practice  at  the  bedside  ;  it  is 
there  that  theory  is  put  face  to  face  with  reality.  In  vain  will  we  have 
stored  our  minds  with  the  precepts  of  the  greatest  masters,  in  vain  shall 


EXTERNAL  THERAPEUTICS.  337 

we  Lave  beard  for  years  together,  the  most  learned  professors,  and  gra- 
ven their  lectures  in  our  memory :  if  we  have  not  followed  them  to  the 
bedside,  if  we  have  not  seen  them  make  a  test  of  their  methods  upon 
the  living,  we  shall  know  very  imperfectly  their  doctrine.  You  may 
possess  very  extensive  general  or  theoretical  notions,  but  you  will  be 
ignorant  of  a  crowd  of  details  which  language  can  not  describe,  and 
which  sight  alone  can  supply.  You  may  be  capable,  perhaps,  to  dis- 
course on  the  most  difficult  questions  in  science,  and  excite  the  applause 
and  admiration  of  an  auditory,  but  you  may  still  be  an  ordinary  or 
feeble  practitioner.  Let  you  be  placed  in  the  presence  of  a  grave  and 
complicated  disease,  and  you  are  required  to  point  out,  from  the  midst 
of  a  crowd  of  symptoms,  those  which  shall  form  the  bases  of  a  curative 
indication,  and  you  will  be  embarrassed  and  troubled.  When,  in  a  peri- 
lous and  urgent  case,  it  is  necessary  to  make  a  prompt  decision,  on 
which  depends  the  life  of  the  patient,  you  will  have  neither  that  correct 
judgment,  that  prompt  appreciation  of  the  case  at  a  glance,  nor  that 
firmness  of  resolution  necessary  for  the  emergency ;  all  this  is  acquired 
by  practice,  and  it  is  clinical  teaching  alone  that  lays  the  foundation  of 
this  practice.  By  this,  though  the  pupil  does  not  practice  himself,  he 
at  least  sees  practice,  and  mingles  with  it ;  he  participates  in  the  prac- 
tice of  the  teachers,  and  acquires  experience,  without  any  danger  to  the 
patient.  Clinical  teaching  is,  in  a  word,  the  indispensable  complement 
of  all  medical  education. 

In  primitive  times,  when  the  science  was  only  composed  of  a  few 
notions,  easy  to  seize  and  retain  in  the  memory,  and  which  were  perpetu- 
ated by  tradition,  without  the  aid  of  books,  there  was  no  other  mode 
of  transmission  in  medicine  than  by  clinical  teaching.  Then  the  lessons 
consisted  more  in  example  than  precepts.  The  pupil  attached  himself 
to  his  master,  in  the  character  of  an  aid,  servant,  or  adjunct.  He 
became  accustomed,  under  his  directions,  to  discern  diseases,  and  pre- 
pare and  administer  medicine.  At  a  later  period,  when  Medicine  became 
the  exclusive  domain  of  some  sacerdotal  families,  this  mode  of  teaching 
was  continued  in  the  Asclepidian  schools.  The  Hippocratic  collection 
offers,  under  the  title  of  Epidemics,  admirable  clinical  narrations,  for  the 
time  when  they  were  written. 

But  after  the  foundation  of  the  school  at  Alexandria,  there  is  no 
further  mention  made  in  the  history  of  Medicine,  of  instructions  being 
given  at  the  bed-side.  Collections  of  clinical  relations,  traced  after  the 
model  of  the  Epidemics  of  Hippocrates,  became  more  and  more  rare, 
because  less  value  was  attached  to  direct  observations.  The  professors 
loved  better  to  descant  on  the  nature  of  man,  the  essense  of  diseases,  the 
elementary  action  of  medicines,  than  patiently  to  observe  the  phenomena, 


338  ERUDITE   PERIOD. 

and  describe  tliem  with  simplicity,  accordingly  as  they  were  presented 
to  the  senses. 

The  invasion  of  the  philosophers  into  the  domain  of  Medicine,  was 
one  of  the  principal  causes  of  the  abatement  of  clinical  observations. 
These  men,  strangers  to  the  practice  of  the  Art,  imagined  themselves, 
and  persuaded  others,  that  it  was  not  necessary,  in  the  study  of  nature, 
to  pause  at  the  phenomena ;  but  that  the  mind  must  penetrate 
beyond  these  sensible  things,  and  seek  the  internal  constitution  of 
entities — their  elementary  and  invariable  principles,  on  which  depended, 
they  said,  the  forms  and  actions  apparent  to  our  senses.  This  was,  if 
we  may  believe  them,  the  unique  means  of  placing  science  on  a  solid 
and  immovable  basis ;  while  the  phenomena,  they  added,  offer  only  a 
shifting  ground,  on  which  nothing  stable  can  be  erected.  The  physi- 
cians, misled  by  these  sophisms,  attempted  to  go  back,  by  the  aid  of 
some  anatomical  and  physiological  notions,  to  the  principle  of  life  ; 
they  hoped  to  unravel  the  mechanism  of  the  most  internal  acts  of  the 
animal  economy ;  and  pretended  to  determine  the  primitive  mode  of 
formation  of  diseases,  or  their  latent  causes,  and  to  direct  the  action  of 
therapeutic  agents  against  the  primary  affection.  They  substituted 
transcendental  hypotheses  for  the  simple  results  of  observation,  and 
believed  that  they  had  raised  the  edifice  of  Medicine  on  an  immovable 
foundation,  because  they  had  established  it  on  a  basis  inaccessible  to  the 
appreciation  of  the  senses,  and  consequently,  they  said,  secure  from 
their  illusions  and  instability. 

By  this  doctrine,  clinical  observation  lost  much  of  its  importance ;  it 
was  no  longer  a  torch  which  could  illuminate  every  step  in  science, 
and  supervise,  constantly,  its  progress ;  it  was  only  a  feeble  and  uncer- 
tain light,  which,  after  having  enlightened  the  cradle  of  human  reason, 
and  served  as  a  basis  to  the  mind,  on  which  to  elevate  itself  to  greater 
truths,  could  henceforth  be  useful  only  to  direct  the  artist  in  the  appli- 
cation of  immutable  rules  which  the  mind  had  discovered. 

In  vain  some  sages,  undeluded,  from  experience,  by  the  fictions  of  theory, 
strove  to  recall  the  medical  world  to  the  study  of  phenomena,  by  pro- 
claiming that  our  light  on  the  nature  of  things  does  not  go  beyond  the 
perception  of  the  senses  ;  in  vain  they  affirmed  that  the  only  means 
of  enlarging  our  knowledge  consists  in  adding,  unceasingly,  new  to  ante- 
rior observations ;  their  voice  was  not  heard,  for  the  human  mind  does 
not  willingly  accede  to  a  slow  pace,  and  the  imagination  loves  better  to 
anticipate  the  march  of  time.  To  the  laborious,  incessant  and  exhaust- 
ing study  of  phenomena,  they  prefered  a  science  fully  made,  having 
invariable  dogmas,  which  were  supposed  to  be  founded  on  the  essense  of 


EXTERNAL   THERAPEUTICS.  339 

things.  Idleness  and  vanity  found  much  more  satisfaction  in  this  last 
doctrine. 

Nevertheless,  the  habit  of  observing  and  describing  facts  as  they  were 
developed,  was  not  entirely  lost.  The  coryphii  of  the  Empirical  sect 
always  remained  faithful  to  it ;  and  tradition  says  that  they  had  col- 
lected in  the  earliest  years  of  the  Alexandrian  school,  a  considerable 
number  of  historical  clinics,  after  which  the  later  nosographers,  Aretseus, 
Coelius  Aurelianus,  and  others  drew  the  portraits  of  a  number  of  dis- 
eases so  well  that  but  little  has  been  added  to  them  since. 

After  the  death  of  Galen,  during  the  lapse  of  time  which  we  have 
named  the  Second  Age  of  Medicine,  and  which  extends  from  the  eleventh 
to  the  fifteenth  century,  the  princes  of  the  science,  in  the  midst  of  their 
habitual  sterility  have  transmitted  to  us  but  a  small  number  of  inter- 
esting clinical  facts,  some  of  which  have  been  pointed  out.  It  should 
be  remembered  that  we  owe  to  the  writers  of  that  stationary  epoch, 
among  other  acquirements,  the  knowledge  of  certain  eruptive  fevers,  of 
which  they  have  given  the  first  description ;  but  they  are  justly 
censurable  for  reporting  none  but  extraordinary  cases,  and  for  having 
omitted,  in  the  most  of  their  clinical  relations,  important  details. 

Long  after  the  revival  of  letters,  clinical  teaching,  so  useful  to  the 
progress  of  science,  and  so  indispensable  j^to  young  practitioners,  was 
still  in  oblivion,  and  this  fact  led  Ph.  Pinel  to  make  the  following 
reflections,  which  may  be  thought  too  severe:  "It  seems,"  says  the 
learned  professor,  "  that  the  first  editions  of  the  ancient  works  of 
the  Greek  physicians,  published  at  the  commencement  of  the  fifteenth 
century,  should  have  led  to  the  restoration  of  clinical  studies  as  the  sole 
guarantee  of  solid  instruction,  and  of  the  ulterior  progress  of  medical 
observation ;  but  this  happy  impulse  of  the  mind  was  still  retarded  for 
more  than  two  centuries  ;  they  plunged  into  all  the  subtilties  of  an 
indigested  erudition — that  is  to  say,  they  were  occupied  solely  with 
commentaries  and  disputes  and  controversies,  as  in  the  other  physical 
sciences  ;  and  they  left  the  sole  method  of  settling  all  uncertainties,  and 
repressing  the  wanderings  of  a  deranged  imagination,  viz.:  the  historic 
description  and  progress  of  diseases  in  the  hospitals." 

I  believe  that  in  the  above  passage  our  celebrated  nosologist  did  not 
fully  appreciate  the  services  rendered  to  science  during  the  Erudite 
Period.  In  fact,  these  physicians  had  not  the  happy  idea  of  founding 
clinical  teaching,  such  as  it  now  exists  in  a  great  number  of  hospitals  ;  it 
is  also  true,  that  they  occupied  themselves  more  with  philological 
researches  than  with  the  observation  of  nature  ;  but  what  better  could 
they  have  done  in  order  to  free  the  human  mind  from  the  rust  which  a 


340  ERUDITE   PERIOD. 

long  course  of  years  had  heaped  upou  it,  thau  restore  the  Greek 
science  in  its  original  purity  ?  This  was  a  painful  and  ungrateful,  but 
necessary  task,  and  which  must  precede  the  labors  of  reformation. 

Nevertheless,  they  did  not  neglect  entirely,  as  is  affirmed  above,  the 
study  of  phenomena,  and  the  historic  description  of  diseases.  They 
began,  from  the  fifteenth  century,  to  make  relations  of  epidemics,  on  the 
model  of  those  of  Hippocrates  ;  they  observed  a  mass  of  new  pathological 
states,  and  attempted  means  of  cure  unheard  of  by  the  ancients.  In 
fine,  in  the  course  of  the  sixteenth  century,  the  spirit  of  innovation 
made  progress,  and  some  physicians  carried  it  even  to  the  point  of  abuse, 
as  we  shall  see  in  the  next  chapter.  But  among  those  who  remained 
faithful  to  the  worship  of  tradition,  enriching,  nevertheless,  the  science 
by  valuable  clinical  observation,  I  will  cite  particularly,  Nicholas 
Massa  of  Venice,  John  Crato  of  Craftheim,  Rembert  Dodoens,  John 
Schenck,  Felix  Plater,  Peter  Forcest,  or  Forestus,  Marcellus  Donatus, 
Louis  Duret,  and  finally  William  Baillou,  worthy  by  his  great  character 
and  his  high  intelligence  and  talent  for  observation,  to  be  the  precursor 
of  the  medical  reform  that  commenced  in  the  following  century. 

Nothing  proves  better  how  much  the  art  of  observation  and  descrip- 
tion of  pathological  phenomena  made  progress  at  the  epoch  of  the  revival 
of  letters,  than  the  great  number  of  new  diseases  of  which  the  authors 
of  that  period  make  mention.  We  read  in  their  writings  for  the  first 
time,  the  names  of  whooping-cough,  milliaria,  scurvy,  plica  polonalis, 
syphilis  and  raphania.  Is  it  credible  that  all  these  diseases,  some  of 
which  modify  the  economy  profoundly,  fell  upon  Europe  at  the  same 
time  ?  Is  it  reasonable  that  the  changes  occurring  in  the  political  and 
commercial  relations  of  the  people — the  discovery  of  the  new  world, 
giving  rise  to  long  voyages  at  sea — in  a  word,  the  modifications  intro- 
duced in  public  and  private  hygiene,  resulting  from  so  many  events 
which  marked  that  epoch,  could  have  suddenly  given  birth  to  this  flood 
of  new  diseases '?  No  one,  I  think,  dare  sustain  it.  It  is  more  probable, 
I  might  almost  say  certain,  that  the  most  of  these  diseases  had  an 
ancient  existence ;  but  they  were  not  recognized  before,  by  attentive 
observers  who  could  discern  their  true  characters,  and  there  were  no 
exact  historians  to  describe  them. 

Medical  men  in  our  days,  are  divided  in  opinion  on  the  origin  of  only 
one  of  these  aflfections — syphilis  ;  some  inclining  to  believe  that  it  was 
developed  spontaneously  in  Europe,  toward  the  close  of  the  fifteenth 
century  ;  others  think  that  it  was  imported  from  the  new  world  ;  others, 
and  the  greater  number,  see  in  the  venereal  diseases  only  a  degeneration, 
or  one  of  the  numerous  ramifications  of  leprosy.     We  now  proceed  to 


EXTERNAL  THERAPEUTICS.  341 

discuss   each  of  these  opinions,  and  will  endeavor  to  make  a   choice 
of  one  of  them :  t 

I.  The  first  view  accords  with  the  opinions  of  the  most  ancient  his- 
toriographers of  syphilis.  Indeed,  the  most  of  the  authors  tliat  have 
first  made  mention  of  this  disease,  have  considered  it  as  a  sort  of  pest 
(lues  venerea),  developed  under  the  influence  of  a  particular  epidemic 
constitution.  They  agree  in  saying  that  it  appeared  nearly  simulta- 
neously in  all  parts  of  Europe — at  Berlin,  Halle,  Brunswick,  inLombardy, 
Apulia,  Auvergne,  etc.  They  regard  it  as  impossible  that  the  conta- 
gion could  be  propagated  in  so  short  a  time,  and  at  such  widely  separated 
points,  as  the  sole  result  of  impure  sexual  commerce,  consequently  they 
are  forced  to  admit  the  influence  of  an  epidemic  constitution. 

But  they  differ  very  much  among  themselves  on  the  causes  that  could 
have  given  rise  to  the  development  of  such  a  constitution.  Some,  like 
Leonicenus,  attributed  it  entirely  to  natural  causes.  He  thought  that 
it  was  the  result  of  the  extraordinary  inundation  that  occurred  in  all 
parts  of  Italy  toward  the  close  of  the  fourteenth  century — the  sun 
having  heated  by  his  rays  the  soil  soaked  by  the  pools  of  stagnant 
water  that  covered  the  low  ground,  there  resulted  unhealthy  exhalations, 
which  gave  rise,  he  said,  to  the  variolus  epidemic.  He  supported  his 
views  on  the  authority  of  Hippocrates  and  Galen.  These  authors  say, 
indeed,  that  in  damp  seasons,  when  the  south  wind  blows,  or  when  no 
wind  disturbs  the  air,  there  are  developed  a  running  from  the  eyes  and 
ears,  ulcerations  of  the  mouth,  pustules,  and  suppurations  of  the  genital 
organs. 

Others  attributed  the  appearance  of  the  pest  to  astrological  influences, 
such  as,  for  example,  the  meeting  of  Saturn  in  the  sign  of  the  Bull,  or 
the  union  of  Jupiter,  Mars,  Mercury,  and  the  sun,  in  the  gign  of  the 
Balance,  etc.  A  large  number  rejected  all  these  learned  explanations, 
and  saw  in  the  propagation  of  this  new  plague  only  the  finger  of  God, 
who  laid  it  on  men,  to  punish  them,  and  turn  them  away  from  unbridled 
libertinism.  Tan  Helmont  regarded  syphilis  as  the  result  of  the  con- 
nection of  a  man  with  a  mare  aff"ected  with  farcin.  Andrew  Gesalpine, 
as  the  product  of  the  mixture  that  the  Spaniards  had  made  of  the  blood 
of  a  leprous  person  with  wine.  Gabriel  Fallopius  thought  the  venereal 
vice  was  engendered  by  a  poison  which  the  perfidious  Xeapolitans  had 
thrown  into  the  wells  whence  the  French  drew  their  water.  These 
reveries  would  not  be  worth  mentioning,  if  they  did  not  indicate 
admirably  the  spirit  of  the  age,  and  show  to  what  a  degree  of  aberration 
a  love  of  the  marvelous  may  draw  the  most  clear-sighted  men. 

II.  Gonzalvo  Ferdinand  of  Oviedo,  Inteudant-General  of  the  commei'ce 
of  the  Xew  "World,  under  Charles  V.,  and  author  of  a  History  of  the 


342   '  ERUDITE   PERIOD. 

East  Indies,  printed  in  1545,  was  the  first  writer  who  said,  positively, 
that  syphilis  originated  in  America.  He  says  that  Christopher  Columbus 
having  returned  from  his  second  expedition  to  the  new  hemisphere,  in 
1496,  the  sailors  and  soldiers  of  his  suit  enlisted,  for  the  most  part, 
under  the  flag  of  Gonsalvo  de  Cordova,  to  go  and  fight  the  French,  who 
had  invaded  the  kingdom  of  Naples.  They  communicated,  he  adds, 
to  the  French  and  Neapolitans  the  affection  they  had  brought  from 
St.  Domingo,  where,  he  asserts,  the  disease  is  endemic  among  the 
natives  of  the  country.  The  statement  of  Oviedo  was  admitted  almost 
without  examination,  by  most  of  the  physicians  of  the  sixteenth  and 
seventeenth  centuries  ;  but  in  the  early  part  of  the  eighteenth,  Astruc 
sustained  it  by  very  erudite  reseai-ches,  which  gave  it  for  a  time  the 
authority  of  a  settled  decision. 

Unhappily  for  the  veracity  of  the  Spanish  historian,  it  is  certain,  from 
authentic  testimony,  that  the  pox  broke  out  in  Naples  toward  the  close 
of  the  year  1493,  or  in  the  beginning  of  the  following  year,  that  is,  two 
years  before  the  arrival  of  the  Spanish  fleet.  We  read,  in  a  decree  of 
the  parliament  of  Paris,  relative  to  venereals,  as  follows :  "  This  day, 
the  sixth  of  March,  (1496  or  1497)  because  in  this  city  of  Paris  there 
are  several  persons  afilicted  with  a  contageous  disease,  called  big  pox, 
which  for  two  years  has  made  great  progress  in  this  kingdom,  as  well 
in  the  city  of  Paris  as  in  other  places,  etc."  If  there  were  needed 
other  proofs  to  invalidate  the  narative  of  Oviedo,  we  might  add,  that 
he  exhibits  in  many  places  a  manifest  prejudice  against  the  inhabitants 
of  the  New  World.  He  likens  them  to  the  Canaanites,  and  the  Spaniards 
to  the  people  of  God,  so  as  to  give  a  color  of  justice  to  the  atrocities 
which  he  inflicted  upon  the  unhappy  Indians  during  his  government. 

Other  later  writers  have  pretended  that  it  was  on  the  first  return  of 
Christopher  Columbus,  that  his  sailors  and  soldiers  carried  into  Europe 
the  syphilitic  infection  ;  but  this  assertion  falls  to  the  ground,  like  the 
preceding,  before  a  serious  examination.  In  fact,  it  is  known,  that  on 
his  return  in  his  first  voyage,  this  bold  navigator  was  assailed  by  a 
tempest  that  forced  him  to  put  into  Lisbon,  where  King  John  II.  retained 
him  seven  days  in  the  midst  of  continual  festivals.  Thence  he  made  sail 
forPalos,  where  he  landed  in  the  course  of  the  month  of  ilarch,  1493. 
From  this  city  he  went  by  land  to  Barcelona,  with  eighty-two  men  of 
his  equipage,  and  nine  Indians.  There  he  met  King  Ferdinand,  with 
Isabella  and  the  whole  court.  After  remaining  some  weeks  at  Barcelona 
he  started  for  Cadiz,  to  prepare  for  a  second  expedition.  Now,  at  none 
of  the  points  where  he  touched  during  his  route,  in  none  of  the  cities 
where  he  stopped  with  his  retinue,  did  the  slightest  symptom  of  the 
venereal  poison  manifest  itself  for  several  years,  while  from  the  year, 


EXTERNAL  THERAPEUTICS.  343 

even,  of  his  arrival  in  Europe,  or  the  year  following,  numerous  attacks 
of  a  venereal  nature  were  observed  in  many  and  very  distant  places 
in  Italy,  France,  and  Germany. 

The  authors  of  this  epoch,  who  assumed  that  syphilis  originated  in 
America,  insist  very  much  on  the  following  consideration,  which  they 
think  of  great  value.  The  Supreme  Intelligence,  they  say,  is  accustomed 
to  place  the  antidote  hy  the  side  of  the  poison ;  now,  guaiacum  wood, 
which  may  be  considered  as  the  most  precious  specific  against  venereal 
accidents,  is  indigenous  to  the  West  Indies,  and  it  follows,  therefore,  that 
the  affection  it  was  destined  to  combat  must  have  originated  in  the  same 
regions.  This  argument  has  lost  so  much  of  its  force  in  its  progress 
down  to  us,  that  there  is  to-day  no  necessity  for  refuting  it. 

III.  The  opinion  that  syphilis  is  a  degeneration  of  leprosy,  or  one  of 
the  numerous  forms  of  this  affection,  seems  not  to  be  as  old  as  the  two 
preceding  ones ;  but  it  has  not  ceased  to  make  progress  in  the  course  of 
time,  and  now  it  reigns  almost  exclusively  in  the  medical  world.  In 
order  to  appreciate  to  what  extent  this  is  probable,  it  is  necessary  to 
place  in  comparison  the  principal  symptoms  attributed  foi-merly  to  the 
two  diseases  under  consideration. 

The  writers  who  wrote  first  on  the  venereal  disease  say,  that  it  com- 
monly commenced  with  large  pustules  on  the  genital  parts,  invading 
subsequently  the  entire  body,  and  hence  obtained  the  vulgar  name  of 
big-pox.  The  pustules  were  not  accompanied  by  fever,  as  are  those  in 
small-pox ;  they  never  came  to  perfect  maturity,  but  were  converted  into 
pustules  adhering  to  the  skin,  or  phagedenic  ulcers.  Very  soon  pains 
were  felt  in  the  extremities,  which  increased  by  the  heat  of  the  bed. 
Then  there  supervened,  after  a  period  more  or  less  long,  a  formidable 
cortege  of  consecutive  developments:  such  as  bubos,  chancres  in  the 
mouth,  nose,  eyes,  and  vegetations  or  excrescences  of  every  form,  alope- 
cia, macules,  exostosis,  necrosis,  etc. 

Blennorrhagia  (les  ecoulements)  now  so  common,  and  which  constitutes 
often  in  itself  the  whole  disease,  was  not  observed  till  twenty  3-ears 
later  as  a  symptom  of  the  syphilitic  infection.  It  was  also  remarked, 
that  the  greater  part  of  the  developments  called  consecutive  or  constitu- 
tional, might,  in  rare  cases,  show  themselves  from  the  commencement : 
that  is,  without  having  been  preceded  by  any  other  symptom  of  the 
infection. 

Some  observers,  struck  with  the  rapidity  with  which  this  epidemic  was 
propagated  at  its  first  appearance,  believed  that  the  contagion  could  be 
communicated  by  the  breath,  even,  of  the  diseased.  However,  gi'cater 
numbers  were  of  the  opinion  that  it  required  the  immediate  contact  of 
the  ulcerated  parts,  or  of  the  running  matter,  and  this  view  soon  became 


344  ERUDITE   PERIOD. 

universal.  Sucli  are,  in  substance,  the  characters  that  were  presented 
at  the  first  appearance  of  the  syphilitic  disease. 

Now,  let  us  see  some  of  those  which  the  ancient  writers  attributed  to 
lepra.  We  read  in  the  sacred  books  of  the  Jews:  "  The  man  on  whose 
skin  or  flesh  a  diversity  of  color  shall  appear,  or  a  pustule  or  any  bright 
spot  which  seems  to  be  the  sore  of  leprosy,  shall  be  taken  to  the  priest 
Aaron,  or  to  some  one  of  his  sons,"  etc.  "  The  man  who  suffers  with 
that  which  should  only  happen  in  the  marriage  relation,  shall  be  impure. 
And  it  shall  be  judged  that  he  suffers  this  accident  when  there  is  a 
constant  accumulation  of  an  impure  humor  which  adheres  to  his  person. 
Every  bed  in  which  he  sleeps,  every  place  on  which  he  sits  shall  be 
impure.  "'••■■ 

Hippocrates,  Aretfeus,  Galen,  Celsus,  and  the  Arabian  physicians 
make  mention  of  gonorrheas  or  issues,  of  the  semen ;  they  speak  of 
pustules,  ulcers,  phlegmons,  excrescences  and  crusts  located  on  the 
genitals  and  neighboring  structures.  The  Latin  satirists,  Horace,  Juve- 
nal, and  others,  describe  some  symptoms  of  this  kind  as  being  the  fruit 
of  a  shameful  lubricity. 

The  writers  of  the  middle  ages  are  more  explicit  than  those  of 
antiquity.  AVilliam  de  Salicet,  who  lived  in  the  thirteenth  century, 
which  is  about  two  hundred  years  before  the  outbreak  of  the  syphilitic 
epidemic,  says  bubos  often  occurred  after  an  impure  coition — quum 
accidet  homini  in  virgd  corriiptio,  ^propter  concuhituni  cum  fcedd  mii- 
liere,  aut  oh  aliam  causam.  Lanfranc  expresses  himself  more  clearly 
still:  "The  ulcers  of  the  penis,"  he  says,  "proceed  either  from  hot 
pustules  which  burst,  or  acrid  humors,  or  from  commerce  with  a  woman 
who  has  been  previously  aifected  in  the  same  manner.  If  one  wishes  to 
preserve  himself  from  all  infection,  it  is  necessary  immediately  after 
connection  with  a  suspected  person,  to  wash  himself  in  a  basin  of  water 
mingled  with  vinegar."!  John  Ardern  makes  mention  of  scalding 
urine,  vulgarly  called  chaude-pisses,  which  was  caused  by  ulceration  of 
the  canal,  or  by  gonorrhea. 

"  It  can  not  be  dissimulated,"  says  a  modern  writer  of  great  weight 
on  this  subject,  "  that  the  resemblance  is  such  in  the  different  varieties 
of  cutaneous  diseases  of  the  present  time,  when  compared  with  those  of 
remote  times,  that  it  is  impossible  in  many  cases  to  decide  if  an  affection 
is  venereal  or  not ;  the  only  thing  that  can  be  alleged  against  the  iden- 
tity is,  that  the  ancients  did  not  represent  these  diseases  as  contagious, 
if  we  except  some  tetters,  corroding  ulcers,  and  the  leprosy. 

'■'  Leviticus,  chap,  xiii,  verse  2 ;  xv,  2,  3,  4 — translation  of  Le  Maistre  de  Sacy. 
See,  also,  in  the  Traite  d'Hygiene  of  M.  Levy,  Paris,  1844,  T.  I,  note  to  page  7. 
fLiv.  III.  chap.  ii. 


EXTERNAL   THERAPEUTICS.  345 

"  Moreover,  one  disease  can  succeed  another  without  presenting  the 
same  symptoms :  it  suffices  if  the  last  has  some  resemblance  to  the 
preceding,  if  it  controls  and  displaces  the  other.  Did  not  this  occur  at 
the  end  of  the  fifteenth  century  and  at  the  commencement  of  the  six- 
teenth ?  In  those  times  leprosy  and  elephantiasis  were  frequent,  and 
there  were  special  hospitals  for  these  diseases  ;  but  gradually  these  hos- 
pitals were  deserted,  and  were  employed  for  other  purposes.  "•■= 

The  sudden  appearance  of  syphilis  in  nearly  all  parts  of  Europe  at 
the  same  time,  which  the  first  observers  have  reported  as  an  extraordi- 
nary, and  nearly  miraculous  thing,  being  persuaded  that  the  disease  was 
new — this  species  of  sudden  ubiquity  for  which  they  could  not  account, 
is  explained  very  naturally,  when  the  venereal  aflPection  is  regarded  as  a 
degeneration  or  modification  of  leprosy,  a  disease  extremely  common  at 
that  epoch.  "VVe  can  conceive  that  from  the  moment  physicians  began 
to  establish  a  line  of  demarkation  between  the  symptoms  of  leprosy  and 
those  of  syphilis,  the  first  must  diminish  in  proportion  as  the  latter 
increased. 

All  the  authors  of  the  times  signalize  the  marked  similitude  between 
the  two  diseases  ;  they  even  say  that  one  may  be  converted  into  the 
other.  Analogous  precautions  were  taken  to  prevent  the  extension  of 
syphilis,  as  had  been  employed  against  leprosy.  The  regulations  for  the 
leprous  hospitals  served  as  a  model  for  those  of  the  lupanars,  for  in  the 
commencement,  the  pox  inspired  a  horror  nearly  equal  to  that  of  leprosy, 
and  this  horror  did  not  diminish  until  increasingly  efficacious  means 
were  found  to  cure  it.  Therefore  the  opinion  which  assumes  that  vene- 
real diseases  have  always  existed,  is  sustained  by  the  greatest  probabili- 
ties, and  if  it  was  not  the  first  one  embraced,  it  is  to  be  accounted  for 
in  the  fact  that  it  flattered  less  the  taste  of  an  age  passionately  fond  of 
the  marvelous. 

Sanchez,  a  Portugese  physician,  was  one  of  the  first  to  oppose  the  idea 
of  the  American  origin  of  syphilis,  and  collected  a  number  of  passages 
which  would  authorize  us  to  think  that  this  affection  commenced  in 
Italy,  as  an  epidemic,  whence  it  rapidly  spread  throughout  Europe.f 

He  submits  the  work  of  Astruc  to  a  luminous  and  severe  criticism, 
and  refutes,  triumphantly,  his  conclusions.  But  this  cfi'ort  was  fruitless, 
and  almost  forgotten,  when  Hensler  took  it  up  nearly  ten  years  later, 

''  CuUerier,  Dictionnaire  des  Sciences  Me Jicales,  on  Syphilis. — Dictionnaire  de 
Medicine  et  de  Chirurgio  Pratiques,  art.  Syphilis,  T.  XV,  p.  176. — M.  Lagneau 
holds  the  same  opinion  on  this  point. — See  Dictionnaire  de  Medicine,  in  21  vol., 
at  the  word  Syphilis. 

t  Dissertation  sur  I'origin  de  la  Maladie  Vene'rienne.  Pai-is,  1752:  Examen 
historique  sur  I'apparition  de  la  Maladie  vene'rienne  en  Europe.     Lisbonne,  1774. 

22 


346  EEUDITE   PERIOD. 

and  supported  it  hy  new  researches,  wliicli  attracted  the  attention  of 
all  Europe,  and  created  doubts  in  many  minds.'' 

M.  Jourdanf  having  examined,  scrupulously,  all  the  opinions  emitted 
up  to  that  time,  on  the  origin  of  these  diseases,  concludes  with  Hensler, 
that  all  the  symptoms  which  it  had  been  usual  to  connect  with  syphilis, 
have  been  known  and  described  from  the  remotest  antiquity,  but  they 
were  not  supposed  to  proceed  from  a  common  source,  (an  impure 
coition)  and  as  being  attached  to  the  same  cause,  until  after  the  close  of 
the  fifteenth  century.  This  last  opinion,  we  have  said,  is  the  most  gene- 
rally received  at  present,  nevertheless,  all  the  syphiligraphs  are  not 
united  in  this  view,  and  we  must  cite  among  those  who  oppose  it,  M. 
Gibert,  whose  authority  is  of  so  much  more  weight,  because  he  has 
•made  on  this  subject  very  erudite  researches.! 


CHAP TEE    IX. 
THEORIES    AND    SYMPTOMS. 

The  prevailing  theory  during  this  period,  as  we  have  already  observed, 
was  a  mixture  of  Galenism  and  Arabism.  Nothing  else  was  taught  in 
the  university  schools  of  Italy,  France,  Germany,  England,  and  Spain. 
Men  standing  at  the  head  either  of  science  or  teaching,  employed  all 
their  sagacity  to  unite  together  the  ancient  doctrines — to  put  in  agree- 
ment, Plato  and  Aristotle,  Hippocrates  and  Galen,  Ehazes  and  Avicenna. 
They  can  all  be  ranked  in  the  class  of  the  conciliators,  with  a  few  excep- 
tions, of  whom  I  shall  speak  in  the  next  chapter.  But  among  them, 
Eerncl  occupies  the  first  place,  and  merits  special  notice  on  our  part. 

John  Fcrnel,  surnamed  the  modern  Galen,  was  born  at  Clermont,  in 
Beauvoisis.  He  exhibited,  from  an  early  age,  an  extraordinary  aptitude. 
and  application  above  his  years.  He  had  made  himself  a  reputation  in 
letters,  philosophy,  and  mathematics,  when  he  began  the  study  of  medi- 
cine. Eeceived  as  doctor  in  1530,  says  his  biographer,  G.  Plancy,  with 
the  unanimous  applause  of  all  the  faculty  of  Paris,  yet  he  did  not  feel 

*'  Geschichte  der  Lustseuche  clie  zu  Ende  des  XV.  .Jalirhunderts  in  Europa 
ausbrach.     Altona,  I7S3,  1791,  2  vol.,  Svo. 

f  Traite  complet  de  la  Maladie  vdne'rienne.     Paris,  1826,  2  vol.,  Svo. 

J  See  the  commencement  of  his  memoir  on  tlie  Syphilidcs,  inserted  in  the  3Ie- 
moires  de  VAcademie  de  Medicine.  Paris,  1843,  T.  X.,  p.  503,  et  als.,  and  liis  Re- 
marques  Ilistoriques  sur  la  Le'pre,  inserted  in  the  Revue  Medicate,  in  the  July 
tind  August  numbers,  1840. 


THEORIES   AND   SYMPTOMS.  347 

that  his  precocious  success  dispensed  with  the  future  study  of  authors, 
as  is  the  practice  of  so  many  laureates,  inflated  by  their  juvenile  erudi- 
tion. On  the  contrary,  he  commenced  reading  with  new  zeal  the  mas- 
ters in  the  Art,  stealing  from  the  hours  of  sleep  and  repose,  every  moment 
he  could,  and  when  his  friends,  alarmed  for  his  health,  represented  to 
him  his  excesses  in  study,  and  persuaded  him  to  take  repose,  he  was 
accustomed  to  reply : 

Longa  quiescendi  tempora  fata  dahimt :  Destiny  reserves  for  us  repose 
enough. 

The  king  of  France,  Henry  II.,  was  desirous  of  attaching  him  to  his 
person,  in  the  quality  of  first  physician  ;  but  the  philosopher  refused 
that  honor,  saying  that  it  belonged,  by  right  of  succession,  to  Bourgeois, 
who  had  been  physician  to  the  late  king,  Francis  I.  But  after  the  death 
of  Bourgeois,  he  had  no  further  excuse  to  make,  and  was  constrained  to 
accept  the  eminent  post,  the  object  of  so  much  solicitation. 

It  was  in  the  midst  of  a  very  extensive  private  practice,  and  the  duties 
of  his  new  charge,  that  he  undertook  to  collect  all  the  medical  knowl- 
edge scattered  in  the  Greek,  Latin  and  Arab  books,  and  to  form  from  it 
a  body  of  doctrines,  all  parts  of  which  would  be  united  together,  as 
branches  are  to  the  same  trunk.  To  this  end,  he  collected  in  each 
author  whatever  he  found  most  substantial,  then  making  a  judicious 
choice  of  the  materials  he  had  collected,  he  gave  them  a  form  appropri- 
ate to  the  taste  of  the  age,  and  composed  from  the  mass  a  work  perfectly 
regular  in  its  arrangements,  and  which  was  regarded  by  his  cotempo- 
raries  as  the  most  complete  and  just  expression  of  medical  science,  as  it 
was  at  that  time  understood.  His  work,  written  with  a  Ciceronean 
purity  and  elegance,  offers  an  extremely  able  fusion  of  the  most  accred- 
ited ancient  dogmas.  We  have  already  exhibited  some  parts  of  that 
doctrine,  and  there  remains  but  little  more  for  us  to  do,  in  order  to 
obtain  a  complete  idea  of  the  work,  and  the  relations  of  its  parts. 

Fernel  emits,  in  the  first  place,  his  opinion  on  the  source  of  our  attain- 
ments, and  on  the  best  method  t»  follow  in  the  study  and  teaching  of 
Medicine.  He  unites,  on  this  subject,  the  doctrines  of  Plato  and  Aris- 
totle, which  appear  to  be  irreconcilable :  the  first  affirming  that  ideas 
come  to  us  by  recollection,  the  second  that  they  originate  in  our  minds 
as  the  effect  of  sensations.  He  attempts  to  show  each  of  them  correct, 
as  follows : 

"  Before  the  mind."  he  says,  "is  united  to  the  body,  it  enjoys  its  full 
liberty ;  it  perceives  distinctly  the  essence  of  things,  aad  possesses  an 
instinctive  knowledge  of  their  nature ;  but  as  long  as  it  is  retained  in  its 
material  prison,  the  body,  oblivion  obscures  its  view,  like  a  thick  cloud, 
and  plunges  it  into  profound  ignorance.     Nevertheless,  it  still  retains  a 


348  EEUDITE   PERIOD. 

slight  remembrance  of  its  divinity ;  and  this  pleasant  reminiscence  of 
celestial  things  becomes  a  ray  which  inflames  it  ■with  an  insatiable 
desire  to  learn  and  to  know.  Hence  that  ardent  zeal  and  constant  appli- 
cation, with  which  it  struggles  to  recover,  by  means  of  sensitive  impres- 
sions, the  mass  of  its  knowledge.  It  commences,  at  first,  with  the 
observation  of  sensible  objects ;  then  it  seizes,  by  its  thought,  those 
which  are  accessible  to  the  intelligence  only.  This,  then,  is  the  process 
by  which  have  been  established,  with  the  aid  of  the  senses,  the  princi- 
ples from  which  human  sciences  have  been  deduced,  and  carried  to  a 
very  high  degree  of  perfection. "=■■' 

What  an  agreeable  mixture  of  truth  and  fiction,  which  the  progress 
of  light  dissipated,  as  we  shall  see  in  the  commencement  of  the  follow- 
ing period.  The  philosophical  theory,  whose  essential  and  fundamental 
dogma  we  have  just  read,  was  eminently  appropriate,  to  kindle  in  young 
hearts  a  love  for  study,  and  to  console  the  learned  for  the  fatigues  and 
privations  that  it  imposed. 

"  The  philosophers,"  continues  the  same  author,  "  desirous  to  rest 
their  doctrines  on  a  lucid  chain  of  rigorous  proofs,  have  employed  analy- 
sis. Such  was  the  method  adopted  by  Euclid,  in  the  exposition  of 
geometry  and  arithmetic ;  of  Ptolemy  in  astronomy ;  such,  also,  the  one 
which  Aristotle  adopted,  in  order  to  transmit  to  posterity  his  philosophy, 
and  lay  the  solid  foundations  of  so  many  truths,  incomprehensible  to  the 
vulgar,  and  which  produce  astonishment  like  prodigies  or  fables." 

What  would  the  metaphysician  Condillac  have  said,  if  this  passage 
had  been  shown  him ;  he  who  believed  analysis  a  scientific  method  of 
modern  invention  ?  We  have  already  seen,  that  this  writer  was  deceived 
in  regard  to  Aristotle — the  effect  of  not  having  read,  or  badly  com- 
prehended him.  We  shall  sec,  further  on,  that  the  description  he  gives 
of  the  analytic  method,  is  imperfect,  according  to  Barthez,  one  of  the 
most  competent  judges  of  our  epoch. 

Fernel  adds,  in  another  book.  "  Seeing  that  the  knowledge  of  those 
individual  objects  is  not  science,  for  the  purpose  of  following  a  sure  and 
rational  method,  I  shall  commence  by  general  considerations."!  This 
method,  we  see,  is  in  perfect  conformity  to  the  doctrine  of  Aristotle, 
which  we  have  already  set  forth,  and  the  artificial  sophistry  of  which  we 
have  unraveled.  Here  is  the  judgment  that  a  sage  of  our  century  gives 
upon  it:  "how  happy  we  would  be,  said  Laromiguiere,  if  these  general 
propositions,  whose  extent  of  application  seems  unlimited,  and  which 
have  been  placed  with  so  much  confidence  at  the  portals  of  science, 
were  as  valuable  as  they  arc  confidently  announced  to  be.     It  would 

"Phjsiol.  lib.  I,  cap.  i.  f  Pathol.,  lib.  i,  cap.  i. 


THEORIES    AND    SYMPTOMS.  349 

then  suffice  to  understand  well  a  few  axioms,  to  be  able  to  comprehend, 
thoroughly,  all  that  it  is  possible  to  know.  But,  I  ask  if  it  is  for  those 
who  already  possess  the  sciences,  or  for  those  who  are  ignorant  of  them, 
that  they  are  embraced  in  a  few  hasty  formula  ?  Certainly  these  are 
not  for  the  ignorant ;  who  will  dare  maintain  this  ?  Now,  if  they  are 
only  the  abridged  expression  of  acquired  ideas,  they  are  only  results, 
and  not  principles."" 

Our  philosopher  concludes,  from  these  reflections,  that  the  general 
propositions,  and  the  axioms,  which  it  had  been  customary  to  place  at  the 
commencement  of  most  treatises,  would  have  been  more  properly  placed 
at  their  end.  But  that  was  not  the  gravest  inconvenience  of  this  bad 
method ;  it  has  another,  much  more  capital,  which  we  have  already 
pointed  out,  but  to  which  it  is  important  to  recur.  This  consists  in 
what  the  axioms  of  physics  and  of  medicine  of  the  ancients  proclaimed. 
These  pretended  principles,  on  which  they  were  willing  to  rest  the  edi- 
fice of  our  acquirements,  instead  of  being  the  result  of  repeated  observ- 
ations, are  the  fruits  of  preconceived  opinions,  and  of  hastily  formed 
judgments  on  things  imperceptible  to  the  senses.  It  is  on  this  account, 
that  when  we  come  to  compare  their  principles  with  particular  facts,  or 
reality,  we  often  find  the  former  in  opposition  to  the  latter.  Whence  it 
follows,  that  their  principles  would  be  defective  or  insufiicient  guides  in 
practice,  which  has  been  proven  by  the  ancients  themselves.  Fernel 
was  compelled  to  avow  it,  notwithstanding  his  prejudice  in  favor  of 
principles,  that  "no  one  could  accomplish  any  thing  great  by  the  simple 
knowledge  of  generalities,  without  the  habit  of  studying  particular 
cases."j  An  old  adage  establishes,  in  a  very  explicit  manner,  the 
antagonism  of  this  philosophic  method,  to  observation,  for  it  says,  posi- 
tively, ''  good  theorist,  had  practitioner."  Here,  unquestionably,  is  a  for- 
mal condemnation  of  the  theoretic  principles  of  antiquity  ! 

Fernel  divides  medical  science  into  three  great  sections,  namely,  phy- 
siology, which  comprehends  the  anatomical  description  of  the  parts, 
pathology,  and  therapeutics.  Each  of  these  divisions  contains  seven 
books : — 

1.  In  the  first  section  we  find  again  the  doctrine  of  Galen  on  the  ele- 
ments, humors,  temperaments,  innate  heat,  radical  moisture ;  on  the 
formation  of  natural,  vital,  and  animal  spirits ;  in  a  word,  on  all  the 
functions  of  the  animal  economy,  as  they  were  understood  by  the  physi- 
cian of  Pergamos.  In  it  is  given  the  explanation  of  the  most  impene- 
trable mysteries  of  the  organism,  in  conformity  with  the  ideas  of  the  age. 
and  with  a  firm  conviction  of  their  truth.     Would  you  know  on  what 

''Lef;ons  de  Philosophic,  1826.    First  part,  §  5.      f  Pathol,  lib.  iv.,  Praefatio. 


350  ERUDITE  PERIOD. 

depends  the  sex  of  infants  ?  Fernel  replies,  in  the  faith  of  the  ancients, 
that  it  depends  on  the  quality  of  the  semen  of  the  father  and  the 
mother.  If  heat  and  dryness,  he  says,  predominate  in  the  two  liquids, 
a  male  will  be  generated ;  if  coldness  and  moisture  predominate,  it  will 
be  a  female.'  Ask  whence  proceeds  the  resemblance  and  want  of  resem- 
blance between  the  parents  and  their  offspring?  Our  physiologist 
answers  you  that  it  appertains  chiefly  to  the  imagination  of  the  mother. 

2.  The  second  section,  that  is,  the  treatise  on  pathology,  offers  us,  in 
the  first  place,  abstract  dissertations  on  the  essence,  the  causes,  and 
symptoms  of  diseases.  We  shall  not  recur  to  this  point,  which  has  here- 
tofore been  alluded  to.  Afterwards  the  author  exposes  the  specific  and 
individual  differences  that  distinguish  morbid  affections  from  each  other, 
and  on  this  subject  he  proposes  a  programme  very  difl&cult  to  fill  up. 
"  As  for  myself,"  he  says,  "I  shall  never  believe  I  have  profound  knowl- 
edge of  any  affection  if  I  do  not  know  positively,  just  as  if  I  could  see 
with  my  eyes,  in  what  part  of  the  human  body  is  its  primitive  seat, 
what  species  of  organic  lesion  constitutes  it,  whence  it  proceeds,  if  it 
exists  idiopathically  or  by  sympathy,  or  if  it  is  kept  up  by  the  presence 
of  some  exterior  cause.  He  who  pretends  to  be  a  rational  physician  must 
sound  each  of  these  subjects,  and  discern  them  by  certain  signs."" 

Where  is  the  pathologist  who  would  now  dare  to  promise  himself  the 
solution  of  such  a  problem,  in  most  diseases  ?  Fernel  regarded  it  solved 
for  a  long  time,  and  aspired  only  to  the  glory  of  thoroughly  compre- 
hending the  sense  of  the  solution  which  had  been  given  by  the  founders 
of  the  doctrine,  and  faithfully  reporting  it.  Here  are  some  propositions 
from  his  pathology,  which  might  be  said  to  be  extracted  from  the  writings 
of  Galen : 

"  Fever  is  an  unnatural  heat,  which  is  propagated  from  the  heart  into 
all  parts  of  the  body.  The  febrile  essence  exists  in  the  heart,  and  being 
opposed  to  the  innate  heat,  falls  furiously  upon  the  organ,  like  an  enemy 
changing  and  troubling  all  its  functions.f 

"  Ephemeral  fever  resides  especially  in  the  vital  spirit,  of  which  the 
heart  is  the  great  reservoir.  Now,  this  spirit  being  extremely  subtile, 
it  results  from  that  that  this  fever  is  the  most  transient  of  all. 

"  Synocha,  or  continued  fever,  is  seated  in  the  humors  of  the  heart 
and  great  veins. 

"  Hectic  is  fixed  in  the  substance  itself  of  the  heart." 

These  propositions,  which  now  appear  so  strange  to  us,  passed  for  fixed 
truths  in  the  days  of  Fernel.  Skepticism  was  at  that  epoch  as  rare  in 
philosophy  and  medicine  as  in  religion.     They  believed  as  much  in  the  v 


-Pathol.,  lib.  V.        flbid. 


THEORIES   AND   SYMPTOMS.  351 

infallibility  of  Aristotle,  Hippocrates,  Galen,  and  Avicenna,  as  in  that 
of  St.  Paul  or  St.  i\.ugustine.  When  an  axiom  in  philosophy  or  an 
aphorism  in  medicine  had  obtained  the  assent  of  the  great  geniuses  of 
antiquity,  faith  was  given  to  them,  without  examination,  as  to  a  dogma 
of  theology  consecrated  by  the  sanction  of  a  Council.  This  shows  us  how 
so  many  errors  were  taught  and  defended  with  entire  conviction,  by  men 
of  lofty  intelligence. 

3.  In  regard  to  therapeutics,  I  have  exposed  sufficiently  at  length  the 
principles  on  which  it  was  founded,  and  the  manner  of  their  application. 
I  shall  content  myself  by  adding  here  some  examples  of  cure,  which  can- 
not be  explained  either  by  the  rule  of  contraries  or  similars,  and  which 
completes  the  refutation  already  given  of  these  two  rules,  and  proves 
more  and  more  the  necessity  of  banishing  them  from  therapeutical 
language. 

First  example. — A  man  having  swallowed,  by  mistake  or  design,  a 
concentrated  solution  of  corrosive  sublimate,  the  physician  called  at  the 
moment  hastens  to  obtain  the  whites  of  eggs,  and  gives  them  to  the  pa- 
tient to  drink.  How  could  a  chemist  explain  the  anti-venomous  action 
of  the  remedy  ?  Shall  he  say  that  the  force  of  the  albumen,  being  op- 
posed to  that  of  the  poison,  formed  an  equilibrium  and  neutralized  it  ? 
Xo.  He  will  say  that  the  mercurial  is  decomposed  by  the  albumen  and 
brought  into  a  state  of  protochloride,  a  substance  insoluble  and  much 
less  deleterious  than  the  sublimate.  There  is  not,  as  we  see  in  this  ex- 
planation, any  idea  of  antagonism  or  similitude  between  the  poison  and 
the  antidote. 

Second  example. — A  young  woman  is  afflicted  with  chlorosis ;  her 
blood  contains  less  fibrin  and  less  red  globules  than  in  the  normal  state  ; 
the  menstruation  is  effected  imperfectly  or  not  at  all.  Feruginous 
preparations  are  ordered,  and  exercise  on  horseback,  with  a  nutrition 
composed  mostly  of  meats.  At  the  end  of  some  months,  on  this  regi- 
men, the  patient  recovers  her  health.  What  relation  of  similitude  or 
opposition  is  there  between  the  pathological  state  of  this  person  and  the 
treatment  employed  ?  It  would  need  very  keen  eyes  to  perceive  between 
these  things,  so  separate,  any  analogy  or  antagonism.  All  that  can  be 
said  is,  that  the  diseased  organs  have  been  put  in  contact  with  new 
modifiers,  by  the  aid  of  which  they  have  returned  to  their  normal  state.. 

Third  example. — A  traveler,  overcome  by  cold,  is  carried  into  an  inn. 
He  is  very  cautiously  kept  from  the  fire,  and  is  rubbed  with  snow.  In 
this  case  the  remedy  has  much  similitude  with  the  morbific  cause.  The 
examples  of  this  order  are  rare,  yet  they  have  sufficed  to  suggest  the 
strange  system  of  Homoeopathy — so  much  is  the  spirit  of  man  inclined 
to  generalize  even  the  most  exceptionable  facts. 


352  EEUDITE   PERIOD. 

Fourth  example. — Let  an  individual  suffer  a  luxation  of  the  femur, 
by  any  accident  whatever.  To  restore  the  bone  to  its  natural  position, 
the  surgeon  must  act  in  a  contrary  sense  to  that  of  the  forces  vyhich 
produced  the  displacement.  In  this  maneuver  there  is  a  manifest  oppo- 
sition between  the  morbid  cause  and  the  remedial  process. 

These  examples  suffice  to  demonstrate  materially,  that  neither  the 
law  of  contraries  nor  the  law  of  similars  can  be  rationally  elevated  into 
a  general  therapeutic  axiom.  If  it  be  desirable  to  establish  an  axiom 
which  embraces  every  case  of  curing,  we  must  seek  it  in  another  class 
of  ideas,  as  we  have  already  insinuated  on  more  than  one  occasion,  and 
which  we  shall  formally  demonstrate  in  the  next  period. 


CHAPTER    X  . 

OCCULT    SCIENCES. 

The  doctrine  which  we  have  developed  in  the  last  chapters  reigned 
almost  universally  in  the  medical  world,  during  the  fifteenth  and  the 
sixteenth  centuries.  Nothing  else  was  taught  in  the  schools,  so  that  it 
may  be  regarded  as  the  orthodox  doctrine  of  those  times.  Nevertheless, 
a  few  voices  protested  against  it,  and  attempted  to  overturn  the  ancient 
edifice  of  Philosophy  and  Medicine.  But  these  voices  had  only  a  pass- 
ing echo ;  they  could  not  arouse  the  mass  of  minds,  because  they  pro- 
posed nothing,  in  the  place  of  a  doctrine  which  had  the  sanction  of  ages 
and  genius,  but  informal  essays  and  undigested  lucubrations.  The  most 
of  the  partisans  of  the  occult  sciences  were  restless  minds,  such  as  are 
found  in  all  ages,  who  bear  impatiently  the  yoke  of  authority,  and  who, 
full  of  confidence  in  their  own  abilities,  will  receive  a  law  from  no  other 
person.  Some  of  these  did  not  lack  sagacity,  imagination,  or  audacity  ; 
but  most  of  them  lacked  connection  of  ideas,  propriety  of  language, 
and  dignity  of  conduct.  Prophets  or  demons,  they  had  among  them- 
selves no  community  of  principles — living  most  of  the  time  isolated 
from  each  other  and  the  rest  of  the  world.  They  became  remarkable  by 
their  oddities,  their  adventures,  and  even  their  misfortunes.  Instead 
of  setting  up  again  the  car  of  reason,  the  sectators  of  the  occult  sciences 
who  gave  the  first  signal  of  revolt  against  the  accredited  doctrines, 
would  have  caused  the  world  to  deviate  still  more,  if  it  had  followed 
their  foolish  direction.  Nevertheless,  we  meet  in  their  writings  some 
useful  truths,  mingled  with  a  mass  of  reveries.     They  have  founded  no 


OCCULT  SCIENCES.  353 

doctrine  worthy  of  a  pliilosopliic  regard ;  but,  by  their  declamation,  they 
forced  the  true  savans  to  leave  the  track  of  the  past,  and  revise  the  ele- 
ments of  our  knowledge,  which  led  to  the  dawn,  in  the  following  period, 
of  an  admirable  scientific  reform." 

I.  The  first  promoter  of  the  occult  sciences  who  is  mentioned  in  the 
history  of  Medicine,  is  Cornelius  Agrippa.  Issue  of  a  noble  family  of 
Cologne,  he  received  a  distinguished  education,  and  possessed  varied  and 
extensive  attainments ;  but  his  natural  inconstancy  and  caustic  humor 
raised  up  enemies  every  where  against  him,  and  prevented  him  from 
becoming  permanent  in  any  locality.  He  led  a  wandering  life,  some- 
times honored  with  the  favor  of  the  great,  and  again  plunged  into 
extreme  misery.  Entering  early  into  the  service  of  the  Emperor  Maxi- 
milian I.,  he  obtained  at  first  the  post  of  secretary,  and  followed  that 
monarch  in  the  array,  where  he  distinguished  himself  by  his  bravery  on 
several  occasions,  and  merited  the  title  of  knight.  Disgusted  very 
soon  with  the  profession  of  arms,  he  quit  it  to  devote  himself  to  the 
study  of  jurisprudence  and  medicine,  between  which  he  divided  his 
time.  His  intemperate  and  bold  pen  soon  drew  him  into  quarrels  and 
persecutions.  At  Dole,  he  fell  out  with  the  monks ;  at  Paris  and 
Turin,  he  compromitted  himself  with  the  theologians ;  at  Metz,  he 
drew  upon  himself  the  formidable  animosity  of  the  Jacobins,  for  having 
attacked,  imprudently,  the  prevailing  opinion  at  that  time,  which  gave 
three  husbands  to  Saint  Ann.  His  oddities  and  incessant  controversies 
obliged  him  to  fly  from  country  to  country.  He  was  a  vagabond,  and 
almost  a  mendicant,  in  Germany,  England,  and  Switzerland.  Thence 
he  went  to  Lyons,  where  at  that  time  resided  Louisa  de  Savoy,  mother 
of  Francis  I.,  and  regent  of  the  kingdom,  who  honored  him  with  the 
title  of  her  physician.  But  Agrippa  found  these  functions  beneath  his 
merits  and  birth,  and  he  did  not  fulfill  them  long.  Having  dared  to 
predict  to  the  superstitious  princess  the  reverses  which  he  believed 
announced  by  the  course  of  the  stars,  he  was  disgraced  and  banished 
from  the  court  of  France.  From  thence  his  evil  star  led  him  to  the 
Low  Countries,  where  he  was  cast  into  prison  on  account  of  his  treatise 
on  the  Vanity  of  the  Sciejices,  and  on  Occult  Philosophy.  Afterward 
he  dared  return  to  Lyons,  and  was  there  incarcerated  anew  for  a  libel 
which  he  had  published  against  his  old  protectrice,  Louisa  de  Savoy. 
Finally,  his  adventurous  life  was  terminated  in  a  hospital  of  Grenoble, 
in  1535,  at  the  age  of  nearly  fifty  years. 

Among  the  works  proceeding  from  his  satiric  pen,  the  most  considera- 
ble, the  one  in  which  the  bitterness  of  his  spirit,  and  the   caustic 

"  Eusebe  Salverte,  Des  Sciences  Occultes,  or  Essai  sur  la  Magie,  les  Trodiges  et 
les  Miracles,  Paris,  1843. 


354  ERUDECE   PERIOD. 

character  of  liis  genius  is  most  liberally  displayed,  is  his  treatise  on  the 
Uncertainty  and  Vanity  of  the  Sciences,  in  which  he  proposes  to  demon- 
strate, "  that  there  is  nothing  more  pernicious  and  injurious  to  common 
life,  and  nothing  more  pestilential  to  the  salvation  of  souls,  than  the 
arts  and  sciences" — a  paradox  renewed  and  sustained  with  much  more 
eloquence  in  the  last  century,  by  J.  J.  Eousseau.  Agrippa  approached 
his  subject  in  a  manner  more  extended  than  the  philosopher  of  Geneva. 
He  commenced,  according  to  the  custom  of  the  times,  by  establishing 
his  proposition  on  scriptural  authority  ;  then  he  supported  it  by  testi- 
mony drawn  from  profane  authors.  Afterward,  he  passed  in  review  the 
various  departments  of  human  knowledge,  the  diverse  occupations  and  pro- 
fessions, and  concludes  from  this  detailed  examination,  that  each  of  them 
does  man  more  harm  than  good.  Courtiers,  warriors,  magistrates, 
churchmen,  proletarians,  ail,  are  cited  to  his  tribunal,  where  they  are 
judged  and  condemned.  He  only  acknowledges  the  value  of  laborers 
and  shepherds,  who,  he  says,  have  produced  the  necessaries  of  life,  since 
the  fall  of  Adam. 

He  speaks  as  follows  of  alchymy,  which  he  had  practiced  a  good  deal : 
"  In  fine,  having  lost  the  time  and  the  money  which  you  have  devoted  to 
it,  you  will  find  yourself  old,  ragged,  hated,  famished,  always  smelling 
the  sulphur,  soiled  with  sweat  and  charcoal,  paralytic  by  frequent  mani- 
pulation of  quicksilver,  and  gaining  nothing  but  a  running  nose ;  in  a 
word,  so  unhappy,  that  you  will  be  willing  to  sell  your  body,  and  even 
your  soul.* 

As  to  lawyers  and  physicians,  we  may  judge  how  he  treated  them,  by 
the  following  facetiousness  :  "  Some  jurisconsuls  and  physicians  were 
disputing  once  for  preeminence :  the  suit  was  heard  by  a  magistrate,  who 
examined  both  parties,  and  noted  their  answers.  '  AVhat  is  the  custum,' 
asked  the  judge,  '  when  criminals  are  led  to  punishment;  in  what  order 
do  the  hangman  and  the  thief  march  to  the  scaffold "?'  They  having 
answered,  that  the  thief  went  first,  and  the  executioner  followed ;  the 
judge  founded  upon  this  report,  his  sentence:  Let  the  lawyers,  then, 
proceed,  and  the  physicians  follow  next ;  showing  in  this  way,  his  views 
of  the  grand  larcenies  of  the  former,  and  the  bold  homicides  of  the 
latter."! 

He  did  not  show  himself  more  gallant  towards  the  fair  sex.  "  The 
court  women,"  he  says,  "  have  also  their  particular  vices.  We  see  some  of 
them  handsome  in  person,  gracious,  agreeable,  genteel,  and  besides  well 

'■'  Paradoxe,  or  the  Uncertainty,  Vanity,  and  Abuse  of  the  Sciences,  by  Agrippa. 
French  translation,  1603,  chap.  xc. 
tibid.,  c,  83. 


OCCULT    SCIENCES.  355 

dressed,  ornamented,  and  enriched  with  gold  rings  and  precious  stones. 
But  it  is  not  easy  for  every  one  to  jDenetrate  with  the  eye,  under  those 
fine  veils,  which  cover  often  hideous  monsters.  On  this  account,  Lucian 
has  justly  compared  them  to  Egyptian  temples,  which  are  beautiful  and 
rich  externally,  constructed  of  elegant  stones,  and  adorned  with  sump- 
tuous works;  but  if  the  gods  were  asked  what  was  within,  to  which 
these  superb  edifices  were  dedicated  and  consecrated,  they  would  answer 
a  stork,  a  monkey,  a  stag,  a  cat,  or  some  other  ridiculous  animal." 

We  will  terminate  the  extracts  from  this  martyrologist,  by  the  follow- 
ing passage,  relative  to  monastic  sects.  "  They  are  joined,"  says  our 
sarcastic  writer,  "  like  all  free  receptacles  for  wanton  sinners,  by  all  those 
who,  afii'ighted  by  their  evil  consequence,  fear  the  rigor  of  the  laws, 
and  who  can  find  no  other  safe  retreat ;  and  by  those  who  have  led  infa- 
mous and  dishonest  lives,  and  are  reduced  to  want  and  beggary,  after 
having  wantonly  dissipated  their  goods  in  brothels  and  taverns,  and 
become  hopelessly  in  debt  to  all  of  them.  Behold  the  great  sea  in  which 
live,  with  other  fish.  Behemoth  and  Leviathan,  enormous  monsters  and 
strange  reptiles,  whose  number  is  infinite. '"=•' 

Let  us  now  look  at  the  morality  of  the  work,  and  we  shall  find  it,  I 
think,  worthy  of  an  adept  of  the  occult  philosophy.  "  If  you  desire  to 
obtain  wisdom  from  the  tree  of  life,  and  not  that  from  the  tree  of  know- 
ledge of  good  and  evil,  reject  all  human  doctrines,  all  the  curiosities 
and  discourses  on  the  flesh  and  the  blood,  re-enter  into  yourselves,  and 
there  you  will  learn  every  thing ;  but  if  you  cannot  perceive  them  by 
clear  and  manifest  intelligence,  as  well  as  the  saints,  it  is  necessary  to 
have  recourse  to  Moses,  to  the  prophets,  to  Solomon,  to  the  evangelists, 
to  the  apostles — for  all  the  secrets  of  God  and  nature,  the  reason  and 
basis  of  all  laws  and  customs — the  kuowledge  of  all  things  present, 
past  and  future,  are  contained  in  the  holy  writings  of  the  Bible." 

The  definite  conclusion  that  Agi'ippa  drew  from  this  book  was  not  as 
strange  to  the  eyes  of  his  cotemporaries  as  it  appears  to  us  now.  Long 
before  him,  erudite  men  of  the  first  order,  such  as  Bessarion,  Pic  de  la 
Mirandole,  Angel  Politien,  Marcellus  Ficin,  had  attempted  to  introduce 
the  ideas  of  Plato  into  physics.  They  thought,  with  that  philosopher, 
the  best  means  of  acquiring  science  and  mastering  the  truth,  consisted 
in  mental  reflection  and  in  isolation  as  much  as  possible  from  all  exter- 
nal sensation ;  besides,  they  admitted  a  correspondence,  sympathetic  and 
antipathetic,  between  the  celestial  bodies  and  the  beings  of  our  sublunary 


*Paradoxe,  or  the  Uncertainty,  Vanity,  and  Abuse  of  the  Sciences,  by  Agrippa. 
French  translation,  1G08,  chap.  cm. 


356  ERUDITE   PERIOD. 

globe.  They  were  persuaded  that  a  great  number  of  phenoraena  and 
events  in  this  world  have  their  origin  in  astral  influences. 

From  this  system  to  the  extravagances  of  the  Cabal  there  is  but  one 
step,  and  which  was  easy  to  take  in  times  of  superstitious  prejudice  and 
religious  excitement.  The  ascetic  Christians  have,  in  fact,  a  belief  that 
approaches  very  much  the  system  of  the  Platoneans.  They  attribute  a 
great  number  of  events  and  phenomena,  not  to  the  influence  of  the  stars, 
but  to  the  direct  intervention  of  the  Divinity  or  the  demon.  According 
to  them,  also,  the  surest  way  to  acquire  science  and  wisdom  consists  in 
uniting  the  soul  to  God  by  meditation,  prayer,  and  the  renunciation 
of  all  exterior  distractions. 

The  following  is  a  summary  of  the  Cabalistic  theory : — All  the  events 
of  life  and  all  the  phenomena  of  nature  proceed  from  the  immediate  in- 
fluence which  God,  or  demons,  or  the  stars  exercised  on  the  archetype, 
that  is  to  say,  on  the  essential  spirit  of  substances.  He  who  is  able  to 
withdraw  this  spirit,  and  knows  how  to  ally  it  to  other  bodies,  possesses 
the  faculty  of  creating  new  beings ;  he  can  fabricate  gold  at  pleasure. 
The  day  and  the  hour  of  our  birthplaces  are  under  the  domination  of  a 
particular  star.  Besides,  each  one  of  our  principal  members  corresponds 
to  some  planet  and  shai'cs  its  constitution. 

Such  is  the  foundation  of  the  occult  philosophy  which  is  divided  into 
four  branches,  namely,  theurgy  or  theosophy,  to  which  a  man  raises  him- 
self by  prayer,  meditation,  and  extasy,  and  which  gives  the  faculty  of 
producing,  like  the  saints,  supernatural  phenomena  by  the  intervention 
of  God ;  magic,  or  the  art  of  controlling  demons,  and  imitating  by  their 
intermediation  true  miracles ;  astrology,  or  the  art  of  reading  future 
events  in  the  stars,  and  predicting  the  fate  of  nations,  the  destiny  of 
men,  and  the  issue  of  diseases  ;  lastly,  alchymy,  which  teaches  the  secret 
of  exti  acting  the  quintessence  or  the  archetype  of  substances,  otherwise 
called  the  philosopher's  stone,  by  means  of  which  the  metals  can  be  trans- 
muted, gold  fabricated,  and  many  diseases  cured. 

Thus  the  errors  of  science,  superstitious  prejudices,  religious  excite- 
ment, and  the  thirst  for  riches,  concurred  at  the  same  time  to  propagate 
the  follies  of  the  Cabal  at  the  close  of  the  middle  ages.  Never  were 
there  seen  so  many  sorcerers,  demoniacs,  astrologers,  and  alchymists. 
Never  were  prophecies,  visions,  and  prodigies  of  all  sorts,  so  common. 
Not  one  remarkable  event  occurred,  but  immediately  it  was  pretended 
that  it  had  been  announced  by  some  previous  sign  or  token.  How  many 
times  was  the  ond  of  the  world  predicted  as  very  close  at  hand,  putting 
in  great  agitatnn  entire  communities — not  only  the  inmates  of  cottages, 
but  even  of  palaces. 


i 


OCCULT   SCIENCES.  357 

But  in  no  country  were  the  Cabalistic  reveries  as  universally  adopted 
as  in  Germany,  where  mysticism  maintained  them  longer  than  elsewhere. 
Luther  himself  seemed  to  share  the  vulgar  prejudices  of  superstition, 
and  contributed  much  to  spread  them.  He  spoke  often  of  struggles 
with  the  devil.  He  said  that  the  evil  spirit  was  accustomed  to  appear 
unto  him  in  the  figure  of  a  monk,  opposing  him  with  captious  syllogisms. 
He  blames  the  physicians  for  attributing  to  natural  causes  many  diseases 
of  which  the  demon  alone  was  the  author. 

The  history  of  this  period  offers  us  everywhere  the  spectacle  of  the 
reign  of  darkness  struggling,  with  forces  nearly  equal,  and  with  balanced 
successes,  against  the  reign  of  light  and  of  truth. 

II.  The  second  propagator  of  cabalistic  Medicine  was  Jerome  Cardan, 
who  was  born  at  Pavia,  the  first  year  of  the  sixteenth  century.  His 
life,  like  that  of  Agrippa,  was  full  of  vicissitudes,  his  character  full  of 
oddities.  His  mother  attempted,  vainly,  during  his  uterine  life,  to 
produce  abortion,  by  the  use  of  certain  drinks.  After  his  birth  she 
took  an  affection  for  him,  and  devoted  to  him  all  the  care  that  his 
delicate  health  required.  But  his  father  never  loved  him  ;  he  treated 
him  like  a  beast  during  his  childhood,  imposing  upon  him  painful  labor, 
above  his  strength.  However,  at  the  solicitation  of  his  mother,  he  con- 
sented, rather  late,  to  send  him  to  a  gymnasium,  where  the  young 
Cardan  learned  the  first  elements  of  the  Latin  language,  grammar,  and 
dialectics.  Afterward  he  embraced  with  very  great  ardor  the  study  of 
mathematics,  philosophy  and  medicine.  He  made  such  rapid  progi'ess 
that  at  twenty-two  years  he  was  capable  to  discuss  publicly,  all  ques- 
tions. Two  years  after  he  received  the  doctor's  hat.  He  practiced 
medicine  in  various  places  till  the  age  of  thirty -three  years,  when  he 
was  named  professor  of  mathematics  at  Milan.  He  kept  this  place 
only  two  years,  after  which  he  traveled  in  Grermany,  France,  and 
England,  and  returned  to  Italy.  He  was  imprisoned  six  months  at 
Bologna,  for  debt,  and  went  at  last  to  Eome,  where  he  obtained  a  pension 
from  the  Pope,  and  where  he  died,  in  the  year  1576. 

The  following  is  the  opinion  of  M.  Dezeimeris  respecting  him  :  "  His 
immense  acquirements,  extraordinary  sagacity,  gTcat  liberty  in  thought, 
his  style,  in  general  manly  and  elevated,  would  have  placed  him  at  the 
head  of  the  most  celebrated  writers  of  the  sixteenth  century,  if  he  had 
not  united  to  so  many  qualities  a  taste  for  paradoxes  and  the  marvelous — 
an  infantile  credulity  and  superstition  hardly  conceivable,  an  insup- 
ptrtable  vanity,  and  endless  boasting."-'  Leibnitz,  a  good  critic  in 
regard  to  talents  and  merit,  judges  him  still  more  advantageously  ;  he 

**  Dictionaire  Hist.  Med.,  at  the  word  Cardan. 


358  '  ERUDITE   PERIOD. 

says,  "  Notwithstanding  his  faults,  Cardan  was  a  great  man,  and  without 
his  defects  would  have  been  incomparable." 

He  wrote  a  great  number  of  works  on  i^hilosophy,  mathematics,  and 
Medicine."  Sometimes  he  admits  without  any  criticism  the  most  absurd 
stories,  visions,  dreams,  sorceries  of  all  sorts,  and  explains  them  by  the 
theories  of  the  Cabal.  Again,  he  affirms  that  he  had  never  devoted 
himself  to  the  cabalistic  art ;  he  blames  those  who  practiced  them,  and 
jeers  at  those  who  have  faith  in  them ;  he  ridicules  those  persons  who 
believe  in  apparitions,  charms,  and  prodigies. 

The  following  principles  on  Chiromancy  are  extracted  from  one  of  his 
works :  "  The  indications  of  strength,  of  valor,  and  voluptuousness,  are 
revealed  by  the  thumb,  which  is  under  the  influence  of  Mars  ;  those  of 
honorable  positions,  civil  or  ecclesiastical  dignities,  are  located  in  the 
forefinger,  which  is  controlled  by  Jupiter.  The  middle  finger,  which  -is 
under  Saturn,  indicates  capacity  for  the  Magical  art ;  it  also  indicates 
melancholy,  poverty,  care,  quartan  fevers,  and  captivity.  The  ring 
finger  submits  to  the  reign  of  the  sun,  and  presages  friendship,  honor, 
and  power.  The  little  finger,  which  is  influenced  by  Venus,  designates 
children,  handsome  women,  and  sensual  pleasures.  Mercury  reigns  over 
the  triangle  on  the  middle  of  the  hand,  where  are  found  indications  of 
erudition,  cunning,  robbery,  etc."  | 

The  history  he  has  written  of  his  life  is  no  less  curious  than  his 
works,  and  no  less  strange  from  the  freedom,  somewhat  cynical,  with 
which  he  confesses  his  errors  and  even  his  vices.  It  is  true  that 
he  attributes  his  faults,  as  well  as  all  the  misfortunes  of  his  life,  to  the 
influence  of  the  stars.  Moreover,  he  loves  to  speak  of  himself  so  much, 
that  he  omits  no  particular ;  he  gives  the  size  of  his  inkstand,  the  cost 
of  his  knife,  the  color  of  his  hair  at  birth,  the  age  at  which  he  lost  his 
teeth,  and  other  trifling  minutise.  Nevertheless,  neither  the  great  num- 
ber of  his  writings  nor  the  versatility  of  his  humor,  would  suffice  to 
explain  his  tcdiousucss,  his  numerous  repetitions,  and  frequent  contra- 
dictions, if  we  did  not  know  that  he  composed  most  of  his  works  under 
the  pressure  of  want;  that  in  his  haste  to  finish  them,  he  often  let  his 
pen  run  at  hazard,  without  any  other  desire  than  to  increase  his  volume 
so  as  to  obtain  a  better  price. 

III.  Paracelsus,  native  of  Marien-Einsiedeln,  a  village  of  Switzer- 
land, twenty  miles  from  Zuerich,  had  no  cause,  like  the  preceding  two, 
to  complain  of  his  lot,  or  of  men.  He  made  more  noise  in  the  world 
while  he  lived  than  many  savans  of  superior  merit,  and  after  his  death 
he  obtained  a  celebrity  which  his  writings  are  far  from  justifying.     His 

"  Hier.  Cardani  Opera,  Cura  Car.  Sponii.    Lugduni,  1663.     Ten  vol.  in  fol. 
■j-  Cardan,  De  Rerum  Varietate,  lib.  xv.,  cap.  lxxix. 


OCCULT   SCIENCES.  359 

father,  wlio  was  a  physician,  gave  laim  his  preliminary  education.  After- 
ward, he  made  him  travel,  according  to  the  custom  of  the  scholastics  of 
those  times,  to  visit  the  universities  and  hear  the  most  celebrated  pro- 
fessors. But  instead  of  frequenting  the  schools,  young  Paracelsus  sought 
the  conversation  of  clever  women,  barbers,  renovators,  magicians,  alchy- 
mists,  in  whose  society  he  boasted  he  had  obtained  valuable  secrets. 
A  very  marked  taste  led  him  at  once  to  the  chimeras  of  the  Cabal.  He 
declares  that  he  did  not  open  a  book  for  ten  years.  He  neglected  to 
such  an  extent  his  academical  studies,  that  he  forgot  the  little  gram- 
mar and  literature  he  had  acquired  in  the  paternal  mansion,  and 
became  incapable  of  expressing  himself  in  Latin  in  an  intelligible 
manner. 

From  the  age  of  twenty-five  years,  he  contracted  the  degrading  habit 
of  strong  drink,  and  the  passion  augmenting  from  day  to  day,  ended  by 
absorbing  entirely  his  reason  and  virility.  It  is  certain  that  he  never 
exhibited  any  inclination  for  women,  whom  he  continually  slandered. 
In  regard  to  the  feebleness  of  his  intellectual  faculties,  hear  what  his 
secretary  and  faithful  disciple,  Oporin,  says:  "During  the  two  yeai's 
which  I  passed  with  him,  he  was  so  strongly  inclined  to  drunkenness 
and  constant  debauch,  that  he  could  scarcely  be  seen  an  hour  or  two  in 
the  day  without  being  full  of  wine,  especially  after  his  departure  from 
Basle  for  Alsace,  where  that  condition  did  not  prevent  him  being  admired 
by  every  one  as  a  second  Esculapius.  Xevertheless,  drunk  as  he  was, 
he  did  not  leave  oif  dictating  to  me  something  of  his  philosophy,  when 
we  had  returned  to  our  lodgings.  Very  often  he  would  get  up  in  the 
middle  of  the  night  and  take  his  sabre,  which  he  boasted  had  been  given 
to  him  by  an  executioner,  and  whirl  it  around,  striking  groat  blows 
upon  the  walls  and  the  floor,  so  that  I  would  tremble,  expecting  every 
moment  that  he  would  split  my  head  open."'-' 

At  that  time,  Paracelsus  was  between  thirty-three  and  thirty-five 
years  of  age,  which  was  the  most  brilliant  period  of  his  life.  His  wri- 
tings, in  which  he  gives  with  great  emphasis,  accounts  of  his  numerous 
successful  cures,  after  the  fashion  of  charlatans,  and  in  which  he  says 
he  is  possessed  of  infallible  secrets  against  the  most  incurable  diseases, 
had  at  last  drawn  on  him  public  notice.  He  had  just  been  called  to 
Basle  to  fill  the  chair  of  Physic  and  Surgery.  A  crowd  of  curious  and 
idle  persons,  and  of  enthusiasts  attended  his  first  lectures,  which  he 
delivered,  not  as  was  customary,  in  the  Latin,  but  in  the  vulgar  tongue. 
The  thaumaturgist,  in  order  to  astonish  his  auditors,  commenced  by  burning 


"'  Oporini  de  vita  et  moribus  Paracelsi,  ad  Solenandrum  et  Wierum  epistola, 
Sennerti  libro  de  consensu  et  dissensu  chimicorum  cum  Gal.  et  Arist.  inserta. 


360  ERUDITE   PERIOD. 

the  works  of  Galen  and  Avicenna ;  then  he  began  to  read  and  develope 
his  own  writings,  breaking  off  from  time  to  time  in  declamations  of  this 
kind:  "  Know,  ye  doctors,  that  my  hat  knows  more  than  you — that  my 
beard  has  more  experience  than  your  academies.  Greeks,  Latins,  Arabs 
French,  Italians,  Jews,  Christians,  and  Mohammedans,  you  must  follow 
me  ;  I  shall  not  follow  you,  for  I  am  your  monarch,  and  sovereignty 
belongs  to  me  !"  =•■■= 

His  vogue  as  professor  was  not  of  long  duration ;  before  two  years  had 
expired,  no  one  was  willing  to  listen  to  him.  He  was  not  less  under- 
rated as  a  practitioner ;  so  that  being  obliged  to  quit  Basle,  in  consequence 
of  some  mishaps,  his  precipitate  departure  created  no  sensation.  He 
resumed  then  the  wandering  life  which  he  always  loved,  and  continued 
in  it  till  the  end  of  his  days.  We  find  him  in  Alsace  in  1528,  at 
Nuremberg  in  1529,  at  St.  Galle  in  1531,  at  Mindelheim  in  1540,  and 
the  year  after  at  Saltzburg.  where  he  died  at  the  age  of  forty-eight,  in 
the  hospital  of  St.  Stephen. 

There  are  few  medical  men  of  whom  so  much  of  good  and  evil  has  been 
said,  as  Pai'acelsus,  and  there  are  few  of  whom  it  would  be  as  difficult  to 
form  a  proper  and  equitable  opinion.  If  we  consult  the  testimony  of  his 
cotcmporaries,  we  find  little  agreement  among  them — they  are  often  in 
direct  opposition  ;  and  if  we  essay  to  enlighten  ourselves  by  the  writings 
even  of  the  author  himself,  we  fall  into  a  chaos  still  more  inextricable. 
Those  who  have  attempted  to  analyse  his  doctrines,  have  abandoned  the 
attempt,  after  efforts  more  or  less  obstinate  and  superfluous.  "  It  would 
be  an  impossible  enterprise,"  svijs  a  modern  historian,  "to  arrange  the 
writings  of  Paracelsus  into  a  systematic  form.  Ideas  without  connection, 
observations  which  contradict  each  other,  and  incoherent  phrases,  defy 
the  comprehension  of  the  best  reader.  Fancy  a  man  who  in  certain 
moments  gives  proof  of  an  admirable  penetration,  and  who,  in  the  next, 
writes  the  veriest  nonsense  in  the  world ;  a  man  who  is  sometimes 
devoted  to  science,  proclaiming  the  absolute  authority  of  experience — 
launching  the  most  violent  anathemas  against  the  theories  of  the 
ancients — and  who  again,  as  if  deranged,  seems  to  converse  with  demons, 
and  to  believe  in  their  omnipotence ;  a  man,  in  fine,  who,  fasting  in  the 
morning  and  drunk  at  night,  yet  put  down  all  his  ideas  in  exactly 
the  order  they  were  presented  to  his  mind.  Such  was  Paracelsus,  whose 
name  entire,  was  Aurelius  Phillippus  Theophrastus  Parcelsus  Bombas- 
tus  ab  Hohenheim. 

"  No  one  can  contest  the  influence  that  Paracelsus  exerted  upon  his 
age.     That  influence  was  certainly  immense.     Why?   How?     Was  it 

^' Preface  to  the  book  entitled  Paraganum,  et  alibi. 


OCCULT   SCIENCES.  361 

because  he  allied  mediciue  and  chemistry  with  the  mystical  doctrines 
of  the  Cabal  ?  Others,  wiser  than  he,  had  already  done  this.  All  the 
Hermetic  philosophers  had  done  it.  Was  it  because,  as  some  think,  he 
was  the  representative  of  the  alchymists  ?  It  is  in  the  middle  ages,  and 
not  in  the  sixteenth  century,  that  we  must  seek  such  a  representative ; 
for  fi-om  the  epoch  of  Paracelsus,  alcbymy  began  to  be  exposed,  and  true 
chemistry  to  be  developed.  He  should,  then,  have  exercised  a  retro- 
grade, instead  of  the  progressive  movement  which  he  brought  about. 
Besides,  the  true  alchymists  of  the  sixteenth  century  did  not  recognise, 
in  any  manner,  Paracelsus  for  their  patron ;  they  do  not  even  allude  to 
him,  no  more  than  if  he  had  not  even  existed. 

"Let  us  endeavor  to  solve  this  question,  which  will  enable  us  to 
comprehend  all  the  influences  that  this  man  exerted  on  his  age  ;  and  in 
the  first  place  let  us  establish,  once  and  for  all,  that  it  is  to  physicians, 
and  not  to  alchymists,  that  Paracelsus  addresses  himself,  and  with 
whom  he  has  controversies.  As  to  alchymy,  his  writings  embrace 
nothing  which  has  not  been  said,  and  a  thousand  times  repeated,  by 
the  theosophs  of  Alexandria,  by  the  Arabians,  Albert  the  great,  Pioger 
Bacon,  Kaymond  Sulle,  etc."  =•' 

Behold  Paracelsus  thus  disowned  by  the  chemists  and  alchymists, 
with  whom,  however,  he  was  supposed  to  be  connected,  whose  works  he 
boasted  that  he  possessed,  and  whose  teachings  he  had  followed ;  whose 
doctrines  he  was  incessantly  praising,  for  he  disdained  the  science  of 
Hippocrates,  Galen,  the  Arabs,  and  the  Arabists.  He  despised  the  course 
of  instruction  given  in  the  universities,  but  highly  valued  what  was 
drawn  from  the  writings  and  experiments  of  the  alchymists.  He  cites, 
with  ostentation,  the  names  of  the  latter,  whom  he  had  the  honor  to 
know,  and  whose  experiments  and  writings  he  had  followed.  "I  have 
diligently  studied,"  he  says,  "under  excellent  masters,  who  were  pro- 
foundly versed  in  that  most  abstruse  and  secret  philosophy  which  they 
called  adept  philosophy,  Xow,  my  masters  were,  first,  William  Hohen- 
heim,  my  father,  who  instructed  me  diligently,  and  several  others,  who 
were  faithful  in  their  teachings  and  concealed  nothing  from  me.  Addi- 
tionally, I  have  studied  the  writings  of  several  distinguished  person- 
ages, the  reading  of  which  has  been  of  great  profit  to  me:  namely, 
those  of  Scheit,  bishop  of  Settgach,  Erard  Levantal,  of  the  bishop 
Nicholas  of  Yppon,  of  Matthew  Schacht,  the  suffragan  of  I'hreisiuo-en. 
of  the  abbot  Spanheim,  and  those  of  several  other  great  chemists.  1 
have  also  become  enriched  with  numerous  and  varied  experiences, 
which  I  learned  from  the  chemists,  among  whom  I  will  name  the  very 


F.  Hoefer,  Hist,  ile  la  Chimie.     Pixris,  184:3  ;  T.  11..  epoch  o,  sect,  i.,  ^  3    n  <) 
23  '  b    .  p.    . 


362  ERUDITE   PERIOD. 

noble  Sigismund  de  Fugex'  de  Scliwats,  who  has  added  very  much  to 
chemistry,  and  greatly  extended  it,  having  maintained  at  great  expense 
several  servants,  whom  he  kept  continually  at  work.""- 

Since  Paracelsus  must  he  erased  from  the  number  of  men  who  have 
contributed  to  the  progress  of  chemistry,  though  he  boasts  on  all  occa- 
sions to  have  improved  it,  let  us  see  what  was  his  influence  on  Medicine. 
Let  us  take  the  best,  or  rather  the  least  exceptionable  of  his  works,  the 
one  in  which  we  meet  the  most  sensible  things  and  the  least  extrava- 
gance— his  "  Great  Surgery."  M.  Malgaigne,  desirous  of  extracting 
the  quintescencc  of  this  work,  to  use  a  common  expression  of  Paracel- 
sus, quotes,  as  an  admirable  extract,  the  following  passage — the  sole 
one,  moreover,  in  which  he  has  found  any  traces  of  a  rational  philoso- 
phy :  "  There  are  two  kinds  of  ways  and  paths,  or  two  methods  and 
fashions,  by  which  to  arrive  at  a  knowledge  of  the  arts.  The  one 
teaches  and  conducts  to  the  truth ;  the  other,  to  illusions.  The  erring 
and  vagabond  discourses  on  the  understanding  and  reason,  are  the 
causes  of  error,  which  occurs  when  they  arc  permitted  to  guide  us. 
Experience,  and  that  which  is  found  familiar  and  in  accordance  with 
nature,  and  which  produces  like  actions,  is  the  cause  of  truth  and 
certainty,  "f 

The  entire  chapter  to  which  this  fragment  belongs,  is  devoted  to  show 
that  arts  in  general,  and  Medicine  in  particular,  are  formed  and  im- 
proved by  experience,  and  not  by  reason ;  for  nature  can  and  wishes  to 
be  known  by  the  aid  of  the  senses  only,  without  needing  to  have  recourse 
to  ratiocination  ;  thus,  we  do  not  know,  by  reason,  what  is  concealed 
within  the  bowels  of  the  mountain — but  by  the  senses,  only,  which  are 
impressed  with  the  things  that  are  seen,  and  reveal  to  our  minds 
their  nature. f  M.  Malgaigne  is  so  astonished  with  the  doctrine  pro- 
fessed in  this  chapter,  that  he  does  not  hesitate  to  proclaim  Paracel- 
sus the  precursor  of  Francis  Bacon,  the  great  reformer  of  philosophy 
and  the  physical  sciences — as  if  this  was  the  first  time  that  such  a 
doctrine  was  put  forth;  as  if  Aristotle  himself  had  not  taught  that  all 
our  ideas  come  from  the  senses,  and  that  the  sciences  are  the  result  of 
observation  and  memory  I  Even  Fernel,  so  reverential  toward  the  an- 
cients, teaches  also,  that  our  first  ideas  arise  from  sensations. 

Yet  this  doctrine  has  not  prevented  Aristotle,  nor  Fernel,  nor  Para- 
celsus, nor  Bacon,  nor  a  crowd  of  others,  from  departing  in  their  theo- 
ries from  the  testimony  of  the  senses,  to  follow  the  phantom  of  their 


"  Grande  Chirurgie,  translated  into  French  by  Dariot,  liv.  ni,  part  i,  chap.  i. 
•j-Ibid,  liv.  II,  tr.  ii,  chap.  i. — Introduction  aux  Giuvres  d'A.  Pare,  part  ii,  §  v, 
pa.  225. 
I  Ibid. 


OCCULT    SCIENCES.  363 

imagination.  Who,  more  than  Paracelsus,  has  falsified  experience  ? 
Open  his  works  wherever  you  may,  ami  you  will  not  find  one  chapter, 
not  one  page,  which  is  in  accordance  with  it.  "  He  proscribes,"  says 
M.  Malgaigne.  (who  endeavors,  however,  to  sustain  him),  "he  banishes 
from  Medicine  the  doctrine  of  four  humors,  upon  which,  after  Galen,  all 
explanations  had  been  founded :  but  he  replaces  one  hypothesis  only  by 
another,  and  all  his  theory,  resting  on  a  doubtful  basis,  crumbles  in  its 
turn  when  it  is  submitted  to  the  test  which  this  supreme  judge  him- 
self has  invoked — experience.     The  following  is  the  sum  total  of  it : 

"  The  human  body,  like  the  great  world  of  which  it  is  an  image,  is 
composed  of  four  elements — fire,  air,  earth,  and  water.  The  fire,  in 
man,  is  the  soul ;  the  earth  is  represented  by  the  dry  parts ;  the  water, 
by  the  liquids ;  the  air,  by  that  which  we  now-a-days  call  gas,  and 
which  he  terms  vacuum :  now  these  four  elements  may  cause  diseases. 
But,  if  we  leave  this  high  analysis,  to  get  at  the  more  immediate  ele- 
ments, the  body  of  man  is  composed  of  mercury  or  liquor,  of  sulphur, 
and  of  salt.  And  now,  see  how  this  is  demonstrated  by  alchymy: 
there  are,  in  the  first  place,  in  the  body,  liquids ;  these  are  the  mercury ; 
then  the  solids  which  may  be  burnt,  and  the  portion  which  burns  is 
sulphur,  while  the  residue,  or  the  ash,  is  salt.  But  this  doctrine  does 
not  belong  to  Paracelsus ;  it  is  found  before,  in  the  writings  of  Basile 
Valentin,  and  even,  it  is  said,  in  those  of  another  alchymist,  anterior  to 
Paracelsus,  Isaac  Hollandus."-' 

The  above  is  what  may  be  collected,  most  rational,  on  physiology,  in 
the  writings  of  this  pretended  reformer.  As  to  anatomy,  he  says  not  a 
word  about  it,  and  for  good  reasons,  because  he  was,  on  this  subject, 
profoundly  igTiorant ;  besides,  he  shows  for  it  a  sovereign  contempt. 
However,  he  recommends  that  great  attention  be  paid  to  the  correspon- 
dence which  exists  between  certain  regions  of  the  great  world,  or  the 
universe,  and  certain  parts  of  the  little  world,  or  the  human  body.  He 
insists,  that  the  physician  should  have  at  his  fingers'  ends,  the  knowl- 
edge of  the  regions  in  man,  named  (after  constellations;,  the  dragon's 
tail,  the  ram,  the  polar  axis,  the  meridian  line,  the  east,  and  the 
west,  etc."f 

The  pathological  doctrine  of  Paracelsus  is  distributed  in  a  great  num- 
ber of  writings ;  but  M.  Malgaigne  having  analyzed  only  the  Great 
Surgery,  has  extracted  only  what  concerns  ulcers,  because  it  is  espe- 
cially in  the  knowledge  of  this  kind  of  lesions  that  the  ph3'sician  of 
Zurich  passes  for  an  expert.     The  substance  of  his  doctrine  on   this 

"(Euvres  d'A.  Pare;  introduction,  t.  I.,  p.  215. 

t  Paragrani,  tract  ii,  De  Origine  Morborum,  lib.  iv,  et  alibi.  See  Daniel  Le 
Clerc,  Essay  on  a  Plan  to  serve  as  continuation  of  the  History  of  Medicine,  p.  806.. 


364  EKUDITE   PEKIOD. 

subject,  is  as  follows:  Ulcers  all  proceed  from  the  corruption  of  the  salt 
that  is  in  us,  and  they  vary  in  nature  according  to  the  variation  of  the 
salt  itself.  Consequently,  Paracelsus  proposes  to  divide  ulcers  into 
ulcers  from  nitre,  scrofula ;  ulcers  from  common  salt,  certain  ulcers  not 
painful,  whose  seat  is  generally  at  the  bend  of  the  arm,  or  in  the  ham ; 
ulcers  from  vitriol,  corroding  ulcers  of  the  legs  ;  ulcers  from  alum,  gan- 
grenous and  fetid ;  ulcers  from  realgar,  malignant  ulcers  of  all  species, 
etc.,  etc."  I  put  aside,  adds  M.  Malgaigne,  after  this  enumeration, 
that  which  treats  of  ulcers  of  another  sort ;  those  which  are  caused  by 
celestial  influences,  or  the  corresponding  constellation  of  the  parts ;  or 
from  special  fluxes,  comparable  to  springs  which  issue  from  the  ground. 
There  ai'e  those  which  originate  in  chaos,  that  is,  from  the  air  which  is 
in  us ;  others  are  produced  by  enchantment ;  in  a  word,  it  is  a  multiple 
doctrine,  odd  and  difficult  to  comprehend  in  its  totality,  and  we  may 
-occasionally  doubt  if  the  author  understood  it  all  himself."="' 

Since,  then,  if  in  considering  only  a  single  work  of  Paracelsus,  and 
that  the  best  of  all,  it  is  impossible  to  deduce  from  it  a  pathological 
theory,  at  all  sensible,  what  would  it  be  if  founded  upon  all,  or  the 
■greater  part  of  the  writings  of  this  prolific  author  ?  We  would  fall  into 
an  inextricable  labyrinth,  into  a  mass  of  unintelligible  nonsense.  Some- 
times he  says  that  all  diseases  arise  from  two  sources,  one  of  which  he 
calls  ex  Cagastro,  the  other  ex  lUastro.  The  diseases  of  the  order  ex 
Cagastro,  come  from  natural  seeds,  like  apples,  pears  and  other  fruits ; 
these  are  hydropsy,  gout,  jaundice,  etc.  The  diseases  of  the  order  ex 
lliastro  are  formed  by  the  decomposition  of  something.  In  this  order 
are  comprised,  the  plague,  pleurisy,  fever,  etc.  Sometimes  he  admits 
five  causes  of  diseases,  to  which  he  gives  the  odd  name  of  morbific 
beings.  The  first  of  these  causes  is  the  Divinity  himself,  ens  Dei ;  the 
second,  the  influence  of  the  stars,  ens  astrale ;  the  third,  the  forces  of 
nature,  ens  naturale  ;  the  fourth  comprehends  the  errors  of  the  imagina- 
tion, evil  influences,  and  enchantments,  under  the  denomination  of  ens 
.spirituale,  or  pagoycum  ;  the  fifth  and  last,  the  ens  veneni,  comprising 
•venoms  and  poisons,  whether  natural  or  artificial. 

Moreover,  he  invokes  another  etiology ;  mercury,  sulphur,  salt,  enjoy 
here  the  role  of  universal  nosogenic  agents.  He  assures  you,  for  exam- 
ple, that  the  mercury  which  is  in  the  animal  body,  being  in  close  rela- 
tionship to  ordinary  quicksilver,  produces,  by  its  volatility,  mania, 
mortification  of  the  ligaments,  tremblings,  etc.  ;  that  if  this  volatility 
■becomes  excessive,  or  if  it  is  joined  to  acrimony,  mania,  phrenzy,  mad- 
ness, etc.,  occur;  if,  on  the  contrary,  the  mercury  is  chilled,  it  causes 

'•■^Introduction  aux  (Euvres  d'A.  Pare.  Paris,  ISiO.  t.  i.,  p.  217. 


OCCULT   SCIENCES.  365 

tremblings  of  the  hands  and  feet,  or  of  the  head  alone,  lethargy,  contor- 
tions of  the  mouth,  eyes,  etc. 

Sulphur  produces  various  kinds  of  fever,  apostema  or  phlegmons, 
jaundice,  etc.  In  separating  itself  from  the  salt,  it  causes  pleurisy, 
inflammation  of  the  stomach  and  liver,  megrim,  diseases  of  the  eyes, 
tooth-ache,  ear-ache,  etc. 

The  salt  gives  the  colic,  causes  stone  and  gravel,  gout  of  the  feet  and 
hands,  sciatica,  etc.  AYhen  it  becomes  dissolved  it  causes  a  diarrhea ; 
if  it  coagulates,  it  causes  indurations,  obstructions ;  if  it  volatilizes  too 
soon,  it  causes  ulcers,  the  itch,  prurites,  erysipelas,  cancer,  herpes,  etc.'-' 

I  have  not  shown  by  far,  all  the  phases  of  this  fantastic  nosology ; 
but  I  pause  for  fear  of  annoying  the  reader,  without  being  able  to  oifer 
him  in  remuneration,  any  thing  valuable.  I  pass  to  his  therapeutics, 
where  we  shall  have,  possibly,  the  happiness  to  meet  with  something 
useful :  some  ingenious  perception  ;  for  this  author  does  not  cease  to  repeat 
that  it  is  not  by  vain  words  that  the  physician  is  to  make  himself 
known,  but  by  his  works  in  curing  the  patients  who  are  confided  to  him  ; 
and  on  that  point,  he  boasts  of  having  cured  a  crowd  of  strange  diseases, 
in  persons  abandoned  by  all  physicians.  Nevertheless,  here  are  some 
witnesses  who  diminish  considerably  the  success  with  which  he  praises 
himself.  Andrew  Libavius,  a  distinguished  physician,  and  great  chemist, 
and  who  was  director  of  the  gymnasium  at  Cobourg,  and  nearly  cotem- 
poraneous  with  Paracelsus,  assures  us  that  the  latter  injured  a  multi- 
tude of  people,  and  did  not  cure  them ;  that  he  killed  a  good  number, 
or  put  them  in  a  worse  state  than  he  found  them ;  in  short,  that  he 
could  not  cure  himself  of  a  cough,  the  gout,  and  a  muscular  contraction 
with  which  he  was  aifected.f  Oporinus,  his  fervent  disciple,  recounts, 
that  when  his  master  was  called  any  where  to  treat  internal  diseases,  he 
could  never  stay  there  more  than  one  year,  and  he  was  accustomed  to 
say  that  he  should  not  practice  any  longer  in  one  place."  It  aj^pears, 
indubitably,  from  these  evidences,  that  if  the  rash  practice  of  Paracelsus 
procured  some  unhoped  for  cures,  it  was  prejudicial  to  a  much  greater 
number,  and  that,  in  short,  he  did  much  more  harm  than  good. 

Pretended  reformer,  who  counts  as  nothing  the  authority  of  the  most 
worthy  writers,  and  relies  on  nothing  but  his  own  experience,  did  he 
really  consult  experience  when  he  proposes,  as  an  excellent  means  to 
discover  the  specific  virtues  of  remedies,  to  observe  what  he   calls  the 

*  Daniel  Leclerc,  Essai  d'lm  plan  pour  servir  a  la  continuation  tie  1'  Histoire  de 
la  Mcdecine,  pp.  809,  810. 

t  Neo.  Paracelsica  inquibiis  vetus  Medicina  defenditur  adversus  G.  Amwald, 
cujus  liber  de  Panacea  excutitur.    Francofurti,  1594,  8vo. 


366  ERUDITE   PERIOD. 

signature  of  tltiruis  2  The  partisans  of  the  occult  sciences,  designated  hy 
this  term  certain  marks  and  variations  of  color  or  figure  which  are 
met  with  in  various  substances,  and  which  indicate,  according  to  them, 
the  essential  projterties  of  these  substances.  Thus,  the  little  yellow  spot 
that  is  seen  on  the  flowers  of  the  cuphrasia,  which  they  compared  to  the 
pupil  of  the  eye.  was,  according  to  their  system,  an  indication  of  the 
cui'ative  virtue  of  this  plant,  in  diseases  of  the  eye.  So  the  seeds 
of  the  pomegranate,  and  various  kernels,  fi'om  tlieir  rcsemblace  to  the 
teeth,  appeared  to  them  as  a  proper  remedy  in  tooth-ache.  The  pulmo- 
nary or  lung  wort,  on  account  of  its  spongy  tissues,  and  the  dark  macu- 
lae on  its  leaves,  had  the  credit  of  being  exceedingly  efficacious  in  lung 
affections.  Citrons  were  supposed  to  be  excellent  cordials,  because  their 
form  represented,  rudely,  that  of  the  heart,  and  because  their  golden 
colour  resembled  that  of  the  sun,  which  corresponds  to  the  heart,  in  the 
macrocosm.  See,  also,  in  the  work  of  Oswald  Croll,  entitled  Basilica 
Oltymica,  the  signatures  of  a  multitude  of  other  substances. 

Paracelsus  has  been  very  much  praised  for  having  made  use  of  chemi- 
cal or  spagyric  remedies.  It  is  true,  that  though  he  did  not  invent 
them,  since  they  were  known  before  him,  he  has  at  least  contributed 
powerfully  to  vulgarise  their  use,  and  this  is  the  sole  merit  which  no 
one  can  contest  with  him.  But  was  this  merit  very  great  and  very 
profitable  to  humanity?     I  will  briefly  examine  this  question. 

In  the  first  place,  it  will  be  admitted,  that  the  more  a  remedy  is 
energetic,  the  more  the  circumspection  and  discernment  which  is  requii-ed 
in  its  employment.  In  the  second  place,  every  one  knows  that  the 
chemical  preparations  recommended  by  Paracelsus,  such  as  the  salts  of 
gold,  antimony,  mercury,  etc.,  have  in  general  very  great  energy.  If, 
then,  we  demonstrate  that  he  administered  these  remedies  with  a  blind 
rashness,  it  will  be  at  (mce  conceded,  that  in  his  hands,  and  those  of  his 
disciples,  they  would  produce  infinitely  more  harm  than  good.  Now, 
it  is  an  agreed  fact,  the  proof  of  which  may  be  seen  in  the  writings  of 
this  author,  that  he  advised  a  crowd  of  very  energetic  medicaments, 
without  any  decided  indication,  without  prescribing  the  doses  in  which 
they  should  be  administered,  or  the  manner  of  preparing  them — an 
omission  so  much  the  more  reprehensible,  as  he  erai»loyed  remedies  but 
little  known.  Each  one  of  his  recipes,  as  he  says,  is  nothing  less  than 
an  admirable  secret,  which  cures  all  diseases,  or  nearly  all,  and  he  alone 
possessed  the  knowledge  of  its  preparation,  which  he  describes,  for  the 
most  part,  in  an  unintelligible  manner.  Let  us  see  how  he  describes 
the  philosophers'  tincture,  the  tincture  of  antimony,  of  corals,  of  potable 
gold,  etc.  A  single  example  will  suffice  to  show  how  little  care  he 
exorcised  in  pointing  out  their  curative  indications.      "  It  should  be 


OCCULT   SCIENCES.  367 

known,"  lie  says,  "  that  as  antimony  purges  gold  only,  and  consumes 
all  othei*  metals,  it  is  the  proper  agent  to  purge  the  human  body,  and 
no  others ;  for  in  regard  to  foi'ccs  and  perfection,  man  has  a  great 
similitude  to  gold  ;  whence  it  follows,  that  antimony  only  brings  man 
and  gold  to  a  supreme  degree  of  perfection  and  purity,  while  it  destroys, 
consumes,  and  corrupts,  everything  else.  The  nature,  then,  of  antimony, 
is  purgative ;  yet  it  does  not  produce  evacuation  of  feces,  and  other 
excremeuts.  but  above  all  other  remedies  which  act  insensibly,  it  drives 
out  that  which  renders  man  impure,  and  having  purged  the  cause  of 
diseases  and  ulcers,  it  brings  man  to  a  supreme  degree  of  health.  Now, 
the  most  eminent  philosophers  have  labored  hard  to  prepare  it,  but  in 
vain  ;  nevertheless,  it  was  finally  perfectly  elaborated,  but  I  must  say 
by  my  own  efforts.  This,  then,  is  the  great  remedy  with  which  we 
must  commence  all  cures,  because  the  ruin  and  destruction  of  many 
patients,  caused  by  the  errors  and  obstinacy  of  physicians,  would  thus 
be  prevented."  ■■■'  He  describes,  immediately  afterward,  the  manner  of 
extracting  the  ve)y  nohle,  very  precious,  and  most  divine  essence  of  the 
jioioer  of  antimony,  which  cures  all  diseases. 

When  we  reflect  on  the  energy  of  a  great  number  of  spagyric  com- 
positions, when  we  think  that  several  of  them  are  violent  poisons, 
instead  of  blaming  the  wise  circumspection  with  which  most  physicians 
have  admitted  them  into  practice,  they  are  entitled  to  our  praise  for 
this  prudence,  especially  at  an  epoch  when  the  process  for  obtaining 
them  in  a  uniform  and  pure  state  was  not  known.  We  are  frightened 
at  the  idea  of  the  ravages  which  the  reckless  and  exaggerated  adminis- 
tration of  these  heroic  remedies  must  have  produced.  Xow  that  their 
effects  are  much  better  known,  and  when  we  know  how  to  obtain  them 
in  a  uniform  and  pure  state,  where  is  the  man  who  dares  gerrci^'ali-ze 
their  use  ?  Who  would  dare  proclaim  a  salt  of  gold,  or  antimony,  or 
other  preparation,  as  an  infallible  remedy  in  all  diseases  ?  None  but  a 
shameless  charlatan,  or  a  physician  of  tlie  lowest  degree  of  ignorance, 
would  pretend  to  do  it.  Thus,  then,  the  extravagant  eulogies  which 
the  Paracelsists  offer  to  certain  chemical  preparations,  the  blind  and 
abusive  emplo3-ment  which  they  made  of  them,  the  frequent  and 
formidable  accidents  of  which  they  were  then  the  source,  far  from  hav- 
ing recommended  such  remedies  to  rational  i)ractitioners,  must  have,  on 
the  contrary,  discredited  them,  and  would  doubtless  have  retarded  their 
introiluction  into  the  materia  medica,  if  more  sensible  experimenters 
had  not  not  been  found — men  more  patient  and  skillful,  to  connect  ^ith 
veritable  indications  these  heroic  but  dangerous  agents.     Thus,  then, 

'  Grande  Chirurgie,  lib.  iii.,  part  1,  chap.  v. 


368  ERUDITE   PERIOD. 

from  whatever  point  of  view  we  regard  the  influence  of  Paracelsus,  in 
physiology,  pathology,  and  therapeutics,  we  find  it  injurious,  and  even 
retrograding,  when  submitted  to  the  test  of  a  severe  analysis. 

Nevertheless,  we  ask  ourselves  how  it  is  that  in  an  age  eminently 
erudite,  a  man  of  scarcely  any  learning,  whose  skill  in  practice  was  very 
questionable,  whose  successes  were  mingled  with  many  reverses,  was 
able  to  exert  on  his  cotemporaries  so  remarkable  an  influence,  and  fill  the 
world  with  the  echo  of  his  renown  ?  A  historian  who  has  made  a  par- 
ticular study  of  the  doctrine  of  Paracelsus,  to  which  he  has  devoted  the 
half  of  a  volume,  shall  answer  this  question  for  us. 

•'  A  revolution,"  says  Sprengel,  "  which  is  based  upon  mysticism,  finds 
access  much  more  easily  to  the  common  people,  than  one  which  is  ef- 
fected by  good  sense ;  because  the  chimeras  of  the  imagination  always 
present  themselves  under  the  liveliest  colors,  and  excite  the  mind  to 
much  more  activity  than  the  severe  conclusions  of  cold  reason.  In  the 
sixteenth  century  Germany  had  enlightened  entire  Europe  by  her  spirit 
of  reformation.  The  mighty  genius  of  Luther  rendered  to  his  cotempo- 
raries, and  to  the  latest  posterity,  the  inestimable  service  of  giving  so 
heavy  a  blow  to  mysticism,  that  Catholicism  and  scholastic  theology 
were  forever  put  down.*  Paracelsus  adopted  the  same  plan,  but  the  fol- 
lowing circumstances  prevented  his  system  finding  as  favorable  and  as 
general  a  reception  as  that  of  the  reformer  in  theology. 

"First,  Medicine  is  a  science  of  experience,  and  to  possess  it,  it  must 
be  learned.  It  rests  on  reasonable  principles  drawn  from  observation ; 
consequently,  a  doctrine  which  rejects  the  testimony  of  reason,  and  which 
represents  experience  as  a  useless  thing,  could  not  have  much  success 
among  physicians.  Secondly,  the  system  of  Paracelsus  was  based  not  only 
on  mysticism,  but  also  on  the  grossest  fanaticism.  In  fact,  superstition 
reigned  despotically  throughout  the  whole  course  of  the  sixteenth  cen- 
tury ;  but  to  give  to  these  same  prejudices  the  appearance  of  a  scientific 
doctrine,  was  an  idea  that  shocked  good  sense  too  much  to  be  generally 
received.  Finally,  Paracelsus  was  not  the  man  to  insure  success  to 
his  system ;  he  was  a  barbarian,  an  ignoramus,  who  despised  all  the 
sciences,  for  the  sole  reason  that  he  was  ignorant  of  them  all.  Though 
he  speaks  much  of  divine  light  as  the  source  of  universal  knowledge,  his 
manners  and  his  vagabond  life  certainly  did  not  prove  that  he  enjoyed 
much  of  its  blessed  influence. 

"  Nevertheless,  his  doctrine  found  in  Germany,  especially,  more  par- 
tisans than  could  have  been  reasonably  supposed.  From  the  calculation 
which  I  have  made  of  the  known  successors  of  Paracelsus,  it  results  that 

■'It  must  not  be  forgotten  tliat  these  are  the  views  of  a  Protestant. 


OCCULT   SCIENCES.  369 

three-fourths  of  them  were  German  born,  but,  for  the  most  part,  men 
without  education,  and  without  any  knowledge  of  the  sciences,  who  threw 
themselves,  soul  and  body,  into  the  arms  of  his  mystic  system,  because 
they  found  there  amply  what  could  supply  their  lack  of  instruction,  and 
incompetency.  Others  held  to  the  medicaments  and  secrets  of  Paracel- 
sus, seeking  to  reconcile  his  theory  with  the  system  of  Galen,  or  at  least 
to  purify,  perfect,  and  render  it  more  plausible."  =••=  Finally,  the  Society 
of  the  Eose  of  the  Cross  applied  his  theories  much  more  logically  than 
had  ever  been  done  before,  to  theology  and  philosophy. 

Thus  this  pretended  reformer,  though  feigning  to  invoke  reason  and 
experience,  addressed  himself  to  the  imagination,  to  superstitious  preju- 
dices, and  mysticism.  His  system,  if  we  can  so  name  an  informal  assem- 
blage of  incongruous  propositions,  by  dispensing  with  all  university 
studies,  favored  idleness  and  ignorance,  and  tended  to  replunge  the  hu- 
man mind  into  the  darkness  of  barbarism,  from  which  it  had  with  so 
much  difficulty  extricated  itself  The  school  which  he  founded  or  prop- 
agated is  nothing  else  than  a  school  of  ignorance,  deception,  and  boast- 
ing— in  a  word,  of  medical  dishonesty ;  a  school  of  which  Thessalus  of 
Tralles  had  been  the  corypheus  in  antiquity,  which  John  de  Gaddesden 
revived  in  the  middle  ages,  and  to  which  Paracelsus  gave  a  new 
development.! 

CONCLrSION   OP   THE   WHOLE   CHAPTER. 

The  men  whose  portraits  we  have  just  sketched,  formed,  with  their 
numerous  sectators,  a  separate  class  of  physicians,  who,  abandoning  the 
slow  march  of  observation  and  reason,  flattered  themselves  with  having, 
at  a  stroke,  attained  omniscience  without  having  made  scarcely  any 
effort  at  study,  by  the  direct  inspiration  of  the  Divinity,  or  by  commerce 
with  demons,  or  by  the  discovery  of  the  secrets  of  magic  and  alchjony. 
The  importance  of  the  part  which  they  played  for  several  centuries, 
required  of  us  to  say  something  of  them ;  but  we  think  that  we  would 
be  far  from  our  aim  if  we  accorded  any  more  space  to  the  exposition  of 
their  errors,  which  seem  to  belong  to  the  history  of  mental  diseases,  as 
much,  at  least,  as  to  the  history  of  the  transformation  of  science.  If 
some  of  these  fanatics  were  impostors  and  tricksters,  the  greater  num- 
ber were  miserable  hypochondriacs  of  the  monomanial  species — dupes  of 

''  Hist,  de  la  Medecine,  sec.  ix.,  chap,  ni.,  t.  in.,  p.  333. 

f  See  the  portrait  of  Paracelsus  drawn  by  Francis  Bacon,  cited  by  Tourtelle  in 
his  Histoire  Philosephique  de  la  Mc'decine ;  Paris,  ISOi,  t.  II.,  p.  313.  See  also  my 
pamphlet  on  Charlatanism  en  Medecine,  inserted  in  the  Revue  Medicalc,  April 
number,  1839. 


370  ERUDITE    PERIOD. 

their  own  hallucinations.  History  shows  ns  that  snch  pretended  sor- 
cerers, alehyinists  or  astrologers — such  self-styled  inspired  of  God  or 
possessed  of  the  devil,  were  so  fully  convinced  of  the  reality  their  vis- 
ions as  to  contend  for  them  in  the  midst  of  tortures,  to  their  latest 
breath. 


CHAPTEE    XI. 
PARTIAL   EFFORTS   FORREFORM. 

While  the  partisans  of  the  Occult  sciences  strove  to  overturn,  com- 
pletely, the  scientific  edifice  of  antiquity,  other  reformers,  less  hold  and 
more  sensible,  without  attacking  in  its  whole  the  old  monuments,  the 
ohject  of  veneration  for  so  many  ages,  disclosed  partially  its  defects,  and 
so  opened  the  way  to  a  radical  reform.  Without  repudiating  in  toto, 
like  preceding  ones,  all  the  traditions  of  antique  science,  they  desired 
that  they  should  not  be  blindly  received  but  after  subjecting  each  one 
to  a  serious  examination,  those  only  should  be  accepted  which  appeared 
in  conformity  with  reason  and  experience,  while  the  rest  should  be 
rejected,  or  subjected  to  such  modifications  as  were  deemed  necessary. 
These  were  generally  enlightened  men,  and,  at  the  same  time,  free 
thinkers — friends  of  regular  progress,  and  not  of  destruction,  whi'jh  has 
always,  a  momentary  retrograde  effect.  They  were  few  in  number  dur- 
ing the  sixteenth  century,  and  did  not  produce  any  capital  work ;  but 
history  must  take  note  of  their  efforts,  because  they  were  the  first  to 
foresee  the  new  route  in  which  succeeding  generations  must  enter,  and 
which  would  lead  to  a  complete  renovation  of  science. 

I.  I  place  at  the  head  of  the  reform  physicians  c>f  the  sixteenth  centui'y, 
John  Argentier  of  Castel-Nuovo,  in  Ticdinont.  He  taught  successivelj'  in 
Naples,  Pisa,  aiid  Turin.  In  his  i.troductory  discourse,  pronounced  in  the 
University  of  Naples,  he  divides  physicians  into  two  classes.  "  The  first, 
persuaded,"  he  says,  "  that  no  improvement  can  be  made  on  the  writings 
and  doctrines  of  the  ancients,  limit  themselves  to  their  study,  and  to 
ascertain  their  true  sense,  without  permitting  themselves  to  add  or 
retract  anything ;  the  other  are  equally  convinced  of  the  necessity  of 
reading  and  meditating  on  these  great  authors  of  antiquity,  yet  do  not 
think  that  all  which  they  advance  is  to  be  received  without  discus- 
sion, but  that  it  is  proper  to  modify,  change  and  improve  them  as  far 
as  possible."" 

*'  In  Artem  IMcdicinalem  Galeni  Commentarii. 


PARTIAL  EFFORTS    FOR    REFORM.  371 

He  does  hesitate  to  pronounce  against  various  jioints  of  the  theory  of 
Galen,  and  contends  with  those  who  have  adopted  them  too  servilely, 
like  J.  Fernel,  and  others.  He  assumes,  for  example,  that  all  parts  of 
the  body  take  their  nourishment  from  the  blood,  and  denies  that  there 
is  any  part  which  is  nourished  by  tlie  semen.  He  proves  that  the  secon- 
dary ([ualities  of  the  body,  such  as  hardness,  softness,  asperity,  etc., 
do  not  depend  on  primitive  or  elementary  (jualities.  He  rejects  the 
multiplicity  of  spirits  with  which  the  Galeuiftts  peopled  the  human  ma- 
chine, and  recognises  only  one  kind,  and  especially  treats  of  the  class  of 
animal  spirits  as  chimerical,  for  the  reason  that  the  reticular  tissue, 
which  is  supposed  to  prepare  them,  does  not  exist  in  man.-'  Unhajpily, 
these  few  new  and  sound  ideas  are  overwhelmed  in  long  and  futile  dis- 
sertations. After  having  displayed  very  great  subtilty,  and  expended 
a  quantity  of  words  to  refute  a  definition  of  Galen,  the  author  proposes 
for  it  another,  which  is  neither  clearer  nor  more  correct.  He  devotes 
seven  large  folio  pages  to  a  discussion  on  the  fiist  aphorism  of  Hippo- 
crates: "  Life  is  short."  In  fine,  though  styled  a  reformer,  Argcntier 
clings  too  much  to  the  ideas  of  Hippocrates,  Aristotle  and  Galen  ;  which 
he  explains,  comments  iipon,  and  discusses,  with  great  prolixity,  limiting 
his  reform  to  changing  a  few  definitions  and  divisons,  without  making 
any  remarkable  innovation  in  the  practice. 

II.  Such  was  not  Leonard  Botal,  who,  without  pretending  to  revolu- 
tionize science,  like  the  former,  introduced  into  the  practice  very  impor- 
tant and  bold  innovations.  Before  him,  the  employment  of  blood-letting 
was  excessively  restrained.  "NVe  have  seen  that  Brissot,  after  a  long 
struggle,  only  succeeded  in  establi:>hing  it  a  little  oftener  in  pleurisy: 
Botal  undertook  to  generalize  it,  or,  at  least,  to  extend  it  to  numerous 
aflPections  in  which  it  had  not  been  employed.  He  advised  abundant 
andnpeated  sanguineous  emi.^sio)is,  not  oidy  in  plcuris}-.  peripneumonia, 
apoplexy,  and  angina,  but  also  in  gout,  dysentery  and  putrid  fevers ; 
not  only  among  subjects  vigorous  and  in  the  strength  of  age,  but  also 
among  children,  old  persons,  pregnant  women,  and  cacochymic  individu- 
als. He  carried  the  paradox  so  far  as  to  sustain  that  an  infirm  old 
man  should  be  bled  from  four  to  six  times  a  year,  and  that  it  was  a 
good  custom  to  open  a  vein  every  six  months,  in  healthy  individuals. 

Botal,  native  of  Astia,  in  Piedmont,  served  at  first  in  the  character  of 
surgeon  in  the  French  army.  Later,  he  became  successively  physician 
to  the  kings  Charles  IX.  and  Henry  III.  His  position,  as  we  see.  must 
have  given  weight  to  his  assertions,  which,  however,  did  not  prevent 
the  Faculty  of  Paris  from  condemning   his  method    as  heretical  and 

"  In  Artem  Mcdiciualem. 


372  ERUDITE   PERIOD. 

dangerous.  He  composed  several  works,  the  most  remarkable  of  which 
is  a  memoir  entitled,  On  the  cure  of  Diseases  by  Blood- Lettimj.  In  this 
book  he  develops  his  paradoxical  ideas  on  the  utility  of  frequent  vene- 
sections. "  The  blood,"  he  says,  "  being  destined  to  nourish  and  sustain 
the  body,  not  to  injure  and  clog  it,  can  only  fulfil  its  destination  in  pro- 
portion to  its  purity  and  proper  quantity.  If,  then,  it  surpasses  the 
just  quantity,  and  if  it  oflFends  in  any  of  its  qualities,  so  as  to  be  incon- 
venient, it  is  necessary  to  correct  it ;  now,  this  is  done  efficaciously  by 
blood-letting,  according  to  the  testimony  of  Hippocrates,  Galen,  and 
especially  as  is  demonstrated  by  the  happy  results  of  this  practice." 

If  the  theory  of  Botal  is  very  contestable,  the  numerous  facts  on 
which  he  supports  it  are  very  much  less  so.  It  can  not  be  denied  that 
he  obtained  extraordinary  success  by  emissions  of  blood  ;  but  as  he  cites 
only  his  successes,  it  is  reasonable  to  suppose  that  he  does  not  cite  all 
the  cases  in  hi^practice.  In  the  second  place,  it  is  necessary  to  remem- 
ber, that  this  physician  having  collected  his  earliest  observations  in 
camp,  on  young  and  vigorous  subjects  in  the  full  strength  of  age,  it  is 
probable  that  he  was  influenced  afterward  by  the  recollection  of  the 
happy  results  which  his^method  produced  for  him  in  the  beginning. 
Finally,  it  may  be  said  in  his  defense,  that  if  he  exaggerated  the  employ- 
ment of  sanguineous  emissions,  his  cotemporaries  made  use  of  it  too 
timidly,  whence  it  follows  that,  all  things  considered,  his  practice  would 
be  as  advantageous,  and  even  more  so,  than  that  of  his  rivals. 

The  memoir  of  Botal  goes  out  of  the  line  of  ordinary  compositions  of 
this  epoch,  as  well  in  regard  to  its  form  as  to  its  matter.  We  do  not  find 
in  it,  as  in  the  others,  subtile  arguments  and  long  theoretical  digressions. 
This  author  says  scarcely  anything  on  theory,  but,  on  the  other  hand, 
mentions  many  facts.  Without  disdaining  the  authority  of  the  ancients, 
on  which  he  sometimes  depends,  he  invokes,  especially,  observation.  In 
fine,  he  unites  independence  and  energy  of  thought  to  elegance  and 
purity  of  style. 

III.  Laurence  Joubert,  Chancellor  of  the  University  of  Montpelier, 
and  consulting  physician  of  the  king  of  France,  Henry  III.,  was  also  a 
liberal  thinker.  In  his  annotations  on  the  books  of  Galen,  he  some- 
times approves,  and  again  he  condemns  the  doctrine  of  this  author. 
Among  other  new  opinions,  he  emits  the  following:  "  That  the  humors 
never  putrify  in  the  living  body,  that  there  is  only  an  effervescence  in 
them,  in  fevers  called  putrid."  His  treatise  on  Popular  Errors  had  an 
unheard  of  success  for  the  epoch  when  it  was  published.  In  less  than 
six  months,  there  were  retailed  4600  copies,  which  must  appear  prodi- 
digious,  when  we  consider  the  small  number  of  persons  who  were  at  that 
time  able  to  read.     Some  of  the  circumstances  that  contributed  to  this 


PARTIAL   EFFORTS   FOR   REFORM.  373 

popularity,  may  be  summed  up  as  follows :  First,  the  Look  was  written 
in  the  common  language,  which  was  a  new  thing  in  works  treating  of 
subjects  connected  with  Medicine,  and  which  placed  it  within  reach  of 
a  crowd  of  new  readers  of  all  classes.  In  the  second  place,  it  was 
diversified  with  jovial  and  vulgar  anecdotes.  In  short,  it  includes,  on 
the  subject  of  generation  and  parturition,  certain  technical  details,  for 
which  men  of  the  world,  unused  to  these  matters,  are  always  greedy. 
The  author,  moreover,  though  affecting  a  light,  paradoxical  and  wanton 
manner,  respects,  at  heart,  religion  and  good  manners.  He  justifies  as 
much  as  possible,  in  his  preface,  the  nudity  of  some  of  his  illustrations, 
and  to  shelter  it  from  too  severe  censures,  he  dedicates  his  book  to  the 
very  high,  very  excellent,  and  studious  Marguerite  de  France,  the  very 
illustrious  Queen  of  Navarre,  daughter,  sister,  and  wife  of  kings. 

I  shall  not  essay  to  analyze  a  work  which  treats  of  a  multitude  of 
disconnected  and  often  unsuited  subjects ;  but  I  will  detach  some  frag- 
ments, by  which  the  style  and  spirit  in  which  it  was  written  ma}^  be 
judged.  The  author  commences  by  a  question  of  high  philosophy, 
which  he  discusses  with  independence  and  discernment.  "  There  is," 
he  says,  "  a  great  contest  between  the  princes  of  philosophy,  Plato  and 
Aristotle,  on  the  condition  of  the  rational  soul,  which  they  both  agree 
to  be  celestial,  divine,  immortal,  and  separable  from  the  body.  But 
Plato  thinks  that  it  does  in  itself  know  all  things,  which  become  effaced 
from  its  memory  and  are  lost  the  moment  it  is  submerged  and,  so  to 
say,  mired  in  our  humid  and  soft  bodies.  Then,  in  proportion  as  the 
body  gradually  dries,  the  soul  becoming  again  clearer  and  more  bril- 
liant, is  restored,  and  gradually  recognizes  everything,  as  if  it  learned  it 
anew  ;  for,  according  to  the  views  of  Plato,  what  we  call  learning  is, 
really,  only  remembering. 

"  On  the  contrary,  Aristotle  afiirms  that  our  soul  unites  with  the 
body  in  entire  ignorance  of  all  things,  but  is  capable,  and  very  promptly, 
of  conceiving  of  all  things,  being  at  first  a  simple  spirit,  but  capalile  of 
all  things  by  degrees.  He  compares  it  to  a  polished  tablet  on  which 
nothing  has  been  drawn,  but  ready  to  receive  every  color  and  figure 
which  may  be  put  upon  it.  This  opinion  has  had  more  partisans  than 
the  former,  and  is  conceived  to  be  true,  by  the  best  philosophers.  For 
if  we  become  wise  by  the  mere  dessication  of  the  body,  it  follows  that 
we  should  have  no  need  of  doctrines,  or  in  other  words,  of  instruction ; 
and  the  mind  could  commit  no  error,  (provided  that  the  exterior 
8ens3S  were  entire  and  sound,)  both  of  which  conclusions  arc  notoriously 
absurd." 

*'  Erreurs  Populaires  au  fait  de  la  Medecine  et  Regime  de  Santc,  par  Laurent 
Joubert.     Paris,  1587.     Preface  to  the  first  part. 


374  ERUDITE  PERIOD. 

We  shall  not  follow  farther  this  author,  in  the  development  of  his  })hi- 
losophic  thesis.  We  will  only  observe  that  he  did  not  seek,  as  l\niel, 
to  conciliate  the  opinions  of  Plato  with  those  of  Aristotle,  but  that  he 
clearly  pronounces  himself  in  favor  of  those  of  the  two  which  seem  to 
him  the  best.  We  see  here  already  a  free  and  clear  thinker,  who  pro- 
fesses for  the  ancients  neither  an  idolatrous  worship  nor  a  blind  contempt, 
but  who  chooses  according  to  his  knowledge  and  taste.  After  having 
sustained  the  conclusion  just  stated,  Laurence  Joubert  explains  the  mo- 
tives which  have  induced  him  to  undertake  the  work,  and  the  end  he 
proposes  to  attain. 

"  Madam,"  he  says,  "  I  leave,  for  the  present,  to  the  theologians  the 
instruction  of  the  soul  in  the  Christian  faith,  to  engrave  this  early  upon 
it,  to  color  it  with  piety,  to  feed  it  with  sound  doctrine,  and  to  perfume 
it  with  odors  agreeable  to  God  and  profitable  to  our  neighbor,  by  a  holy 
and  exemplary  life,  conforming  to  doctrine  and  proceeding  from  piety, 
having  its  strength  in  faith  of  the  highest  character.  I  hold  to  what  is 
my  vocation,  that  is,  the  care  of  the  human  body,  to  preserve  its  health 
and  restore  it  when  deranged,  by  the  help  of  the  grace  of  Almighty  God, 
who  has  created  Medicine  and  established  the  physician  for  the  necessi- 
ties of  man.  In  this  vocation  I  have  for  a  long  time  (for  at  least  twenty- 
five  years)  labored,  for  a  double  aim — the  one,  to  instruct  the  youth  in 
the  said  science,  as  well  by  writing  as  by  verbal  teaching,  sincerely  and 
diligently  giving  them  the  first  traits,  watering  it  with  good  precepts, 
making  them  acijuainted  with  the  most  secret  remedies,  and  exercising 
them  in  discussion  and  practice ;  the  other,  to  extinguish  and  annul 
several  false  opinions  and  errors  (offsprings  of  ignorance)  which  have 
long  been  valued  and  in  fashion  in  Medicine,  Surgery,  and  Pharmacy — I 
say,  among  the  professors  of  the  three  departments  of  our  Art,  from 
which  has  resulted  many  abuses  and  nullities. 

"  But  all  this  is  trifling,  compared  with  the  popular  errors  in  Medi- 
cine and  the  regimen  of  health,  which  for  the  most  part  are  so  stujiid 
and  vulgar  as  to  merit  much  more  ridicule  than  reprehension.  Never- 
theless, because  they  are  very  prejudicial  to  the  life  of  man,  it  seems  to 
me  that  we  must  neither  despise  nor  dissimulate  them,  but  rather  remon- 
strate with  the  ignorant  vulgar  in  regard  to  what  and  how  they  err  and 
go  astray,  trying  to  lead  them  in  a  better  path.  For  they  do  not  act 
maliciously  or  with  an  intention  to  injure,  but  for  the  best,  according  to 
their  opinion.  It  belongs,  then,  to  physicians  to  i-emcdy  this  evil,  to 
corr:  ct  which  I  have  taken  great  pains  for  a  long  time,  and  remonstrated 
with  many.  But  that  has  been  of  little  moment,  as  long  as  the  greater 
number  are  incapable  of  reason  and  discussion.  Finally,  1  have  deter- 
mined to  remonstrate  with  the  people,  showing  up  their  en-ors  by  writing, 


PARTIAL   EFFORTS   FOR   REFORM.  375 

and  in  order  to  set  up  a  judge  wholly  unsuspected  l)y  them,  yet,  never- 
theless, capable  of  correcting  such  abuses. 

"  Now,  having  long  reflected  who  this  judge  should  be,  the  excellency 
of  your  majesty,  madam,  has  seemed  to  me  the  most  proper  one  in  the 
world,  by  the  rare  virtues  which  every  one  admires  in  you,  your  most 
angelic  spirit,  your  exquisite  judgment,  your  honest  curiosity  and  stu- 
elious  desire  to  know  all  things,  and  also  on  account  of  the  leisure  you 
possess  for  such  a  pastime,  which  will  serve  you  as  a  gi-eat  recreation  for 
several  hours  a  day,  to  understand  and  examine  the  reasons  I  have 
deduced  against  popular  errors,  in  order  to  overturn  them.  I  shall,  how- 
ever, fear  the  venomous  and  envious  tongues  who  will  endeavor  to  find 
something  unbecoming  in  what  1  jiropose  to  your  majesty  on  this  subject; 
for  I  am  constrained  frequently  to  say  things  which  appear  too  filthy  and 
lascivious ;  but  knowing  that  one  may  honestly  speak,  as  I  have  done, 
on  all  the  natural  functions,  as  well  as  on  all,  even  the  most  secret  and 
hidden  parts  of  the  human  bod}',  which  chaste  eyes  do  not  fear  to  see 
represented  in  public  by  drawings  and  sculpture ;  rememberiug,  too, 
what  Dion  recounts  of  the  virtuous  Roman  princess  Livia,  wife  of  the 
emperor  Augustus,  who  saved  the  lives  of  men  condemned  to  death  be- 
cause they  had  exposed  themselves  before  her  entirely  naked — she  say- 
ing, that  to  the  observation  of  a  virtuous  woman  they  differed  in  nothing 
from  statues,  I  consider  myself  fortified  by  such  reasons,  as  by  defen- 
sive arguments,  against  which  the  poison  of  slanderers  can  avail  nothing 
with  you."'  • 

We  see  by  these  citations — first,  that  Joubert,  in  writing  the  book  we 
have  mentioned,  proposed  for  himself  a  serious  and  useful  end — that  of 
combating  prejudices  no  less  injurious  than  ridiculous ;  secondly,  that  he 
justifies  very  adroitly  the  licenses  of  expression  in  which  he  has  in- 
dulged, as  well  as  the  odd  idea  he  had,  of  dedicating  such  a  book  to  a 
woman.  Besides,  it  appears  that  the  very  studious  queen  of  Navarre 
does  not  show  herself  on  this  occasion  more  severe  than  the  Eoman  em- 
press, and  that  she  deigned  to  accept  the  dedication  of  the  Chancellor  of 
the  University  of  Medicine  at  Montpclier.  We  may  judge,  by  the  fol- 
lowing announcement  of  several  of  the  questions  agitated  in  this  work, 
if  it  was  not  calculated  to  excite  the  curiosity,  I  will  not  say  of  a 
princess,  but  of  the  generality  of  readers. 

The  entire  work  is  divided  into  two  parts,  at  the  close  of  which,  is 
added  a  mixture  and  collection  of  other  (questions  and  popular  errors, 
collected  by  him  and  his  friends.  The  following  are  some  of  the  propo- 
sitions, each  of  which  forms  the  title  of  a  chapter.     "Why  are  there 

^'Erreurs  Populaires  au  fait  de  la  Medecine  et  regime  dc  sante. 


376  ERUDITE   PERIOD. 

more  jiliysicians  than  other  sorts  of  people  ?'  '  It  is  not  profitable  to  sick 
persons  to  have  several  physicians,  but  one  alone,  who  should  be  very 
assiduous.'  '  Can  a  woman  conceive  without  having  her  courses  ;  in 
other  words,  without  her  natural  purgatives  V  '  Against  those  who  keep 
up  sexual  intercourse,  with  a  view  of  having  children,  and  of  those  who 
indulge  but  seldom,  in  order  to  have  less.'  '  If  thei-e  is  any  certain  know- 
lege  whether  the  child  will  be  male  or  female,  and  whether  there  will  be 
one  or  two  ?'  '  Why  is  a  pregnant  woman  advised  to  put  her  hand  on  her 
posteriors,  if  she  cannot  satisfy  her  desires  ?'  '  Is  it  good  to  make  a 
woman  sit  on  the  bottom  of  a  hot  kettle,  or  put  on  her  belly  the  cap  of 
her  husband,  in  order  to  have  a  better  delivery ;  and  what  are  the  best 
means  for  accouchement  ?'  '  Is  it  true  that  a  woman  delivered  in  full 
moon,  will  afterwards  have  a  boy,  and  if  in  new  moon,  a  girl  ?'  '  An 
exhortation  to  all  mothers,  to  nurse  their  own  children.'  '  Is  there  a  cer- 
tain sign  of  the  maidenhood  of  a  girl  ?'  '  On  the  superstitious  and  false 
opinions  of  women,  who  believe  that  the  milk  of  a  woman  will  dry  up 
in  her  breast,  if  some  of  it  be  heated.'  '  Is  it  true  that  truffles,  arti- 
chokes, and  oj^sters  render  men  more  keen  for  venereal  pleasures?'  &c." 
The  author  treats  these  delicate  matters  in  a  manner  worthy  of  the 
subject,  mingling,  as  we  have  said,  his  serious  dissertations  with  amusing 
anecdotes.  Thus,  after  having  shown  the  ridiculous  presumption  of  so 
many  men  assuming  to  act  as  physicians  without  understanding  any 
thing  about  it,  and  that  too,  in  the  presence  of  physicians,  he  narrates 
the  following  adventure  :  "  It  is  said  that  the  duke  of  Ferrara,  Alphonso 
d'Este,  at  one  time  proposed,  in  a  familiar  way,  the  question,  in  what 
calling  are  most  men  engaged :  One  said  shoemakers,  another  tailors,  a 
third  carpenters,  mariners,  pettifogers.  and  laborers.  Gonelle,  his 
famous  buffoon,  said  there  were  more  physicians  than  any  other  class  of 
men,  and  made  a  bet  with  the  duke,  who  denied  it,  that  he  would  prove 
it  in  twenty-four  hours.  The  next  morning  Gonelle  left  his  lodgings, 
wearing  a  great  night-cap,  and  a  cravat  tied  around  his  chin,  then  a  hat 
over  all,  and  his  mantle  drawn  up  over  his  shoulders.  In  this  attire, 
he  took  a  route  leading  to  the  palace  of  his  excellency,  through  Angel 
street.  The  first  one  he  met  asked  him  what  was  the  matter  ;  he  replied 
that  he  had  a  raging  tooth-ache.  Ha !  my  friend,  said  the  other,  I 
know  the  best  recipe  in  the  world  against  it,  and  told  it  to  him.  Gon- 
elle inscribed  his  name  on  his  tablets,  pretending  that  he  was  writing 
down  his  recipe.  A  step  further  on  he  found  two  or  three  together,  who 
all  asked  the  same  question,  and  each  one  gave  him  a  remedy.  He 
inscribed  their  names  as  the  first ;  and  thus  he  pursued  his  course  very 
gingerly  to  the  end  of  the  street,  not  meeting  a  single  person  who  did 
not  offer  him  a  recipe  different  from  the  rest,  each  one  saying  that  his 


PARTIAL  EFFORTS    FOR   REFORM.  377 

was  well  established,  certain,  and  nearly  infallible.  He  wrote  down  the 
names  of  all.  Coming  to  the  lower  court  of  the  palace,  he  found  him- 
self surrounded  with  gentlemen,  (for  they  all  knew  him,)  who,  after 
having  learned  his  affliction,  compelled  him  to  take  their  recipes,  which 
each  one  said  was  the  best  in  the  world.  He  thanked  them  all,  and 
wrote  down  their  names.  "When  he  entered  into  the  chamber  of  the 
duke,  his  excellency  cried  out,  'Eh  !  what  have  you  got  Gonelle?'  He 
replied  very  piteously  and  complainingly,  '  tooth-ache,  the  worst  that 
ever  was.'  To  which  his  excellency  replied,  '  ha !  Gonelle,  I  know  a  thing 
which  will  drive  off  the  pain  at  once,  without  touching  the  tooth.  Mr. 
Antonio  Musa  Brussavola  has  never  employed  a  better  one.  Do  so  and 
so,  and  incontinently  you  will  be  healed.'  Suddenly,  Gonelle  threw  down 
his  head  dress,  and  his  attire,  crying  out,  '  and  you  also,  my  lord,  are  a 
physician  !  Look  at  my  list,  and  see  how  many  others  I  have  found, 
between  my  lodgings  and  your  palace.  Here  are  nearly  two  hundred, 
and  I  have  only  passed  through  one  street.  I  will  engage  to  find  ten 
thousand  in  this  city,  if  I  go  every  where.  Find  me  as  many  persons 
in  any  other  business.'  This  is  an  appropriate  story ;  in  fact,  every  one 
meddles  with  medicine,  and  there  are  few  men  who  do  not  think  that 
they  know  a  great  deal  about  it,  and  even  more  than  physicians  th em- 
selves.  "=■■' 

I  have  dwelt  somewhat  at  length  on  this  work  because,  under  its  light 
form  and  without  affecting  any  pretension  to  scientific  depth,  it  has, 
nevertheless,  an  end  eminently  useful,  namely,  to  dissipate  a  multitude 
of  errors  which,  when  practiced,  produce  bad  results ;  and  in  attempting 
to  enlighten  the  vulgar,  was  he  not  laboring  for  the  propagation  of  sound 
doctrine  ?  However,  I  must  say  that  we  find  in  the  book  of  Joubert 
the  sanction  of  certain  erroneous  theories  which  then  reigned  supreme 
in  science ;  but  this  was  an  inevitable  defect,  for  an  author  would  not 
be  able  to  combat  vulgar  prejudices  with  other  lights  than  those  of  his 
own  age. 

''  Erreurs  Populaires,  part.,  liv.  i.,  chap.  ix. 


24 


378  erijDite  period. 

OHATTEE  XII. 
MEDICAL  ORGANIZATION  AND  ACCESSORY  INSTITUTIONS. 

The  separation  of  Medicine  from  the  priesthood,  which  hegan  to  take- 
place  at  the  close  of  the  preceding  period,  was  completed  during  this,  to 
the  great  advantage  of  both  professions,  for  though  the  Pagan  priest 
could  practice  the  Healing  Art  without  derogation  to  the  rules  of  his 
order,  the  Catholic  priest  could  not,  without  defilement  and  a  violation 
of  the  canons  of  the  church,  descend  into  a  mass  of  sensual  details 
which  the  study  and  practice  of  Medicine  required.  From  the  sixteenth 
century,  celibacy  ceased  to  be  obligatory  on  physicians  in  the  kingdom 
of  France,  and  they  no  longer  obtained  ecclesiastical  benefices.  At  the 
same  time.  Surgery,  which  had  long  been  separated  from  Medicine,  reap- 
proached  it,  and  this  approach,  as  we  have  seen,  turned  to  the  profit 
of  science. 

From  this  date,  the  professors  of  the  Surgical  College  of  St.  Come 
were  put  on  the  same  level  with  the  professors  of  the  University,  and 
enjoyed  equal  privileges. 

In  fine,  the  establishments  destined  to  propagate  medical  instruction, 
faculties  and  schools  of  Medicine,  increased,  and  those  which  already 
existed  were  developed.  Amphitheaters  for  dissection  were  opened  in 
every  State  in  Eui'ope.  The  hospitals  and  dispensaries — in  a  word,  all 
the  institutians  devoted  to  the  comfort  of  the  afflicted  poor,  followed  the 
upward  march.  The  governments  turned  more  of  their  solicitude 
toward  the  regulation  of  medical  police  and  hygiene,  and  then  com- 
menced an  amelioration  in  the  sanitary  state  of  the  people. 

RESUME    OF    THE   ERUDITE    PERIOD. 

The  historical  period  whose  state  we  have  just  sketched,  offers  a  most 
interesting  spectacle.  We  have  seen  the  human  mind,  long  buried  in  a 
lethargic  sleep,  gradually  awake,  and  mark  its  first  steps  by  discoveries 
of  the  highest  importance ;  the  love  of  letters  became  general,  as  the 
means  of  instruction  multiplied ;  science,  enclosed  in  the  cloisters  during 
the  middle  ages,  became  secularized  as  in  the  times  of  Hippocrates, 
Plato,  and  Aristotle,  but  with  the  means  of  propagation  more  numerous 
and  efficient.  The  first  effect  of  this  expansive  movement  of  the  mind 
was,  to  re-direct  the  attention  of  the  learned  world  toward  the  primitive 
sources  of  the  beautiful  and  the  true ;  the  debris  of  Greek  literature 
was  exhumed  from  the  dust  of  the  libraries  of  the  convents,  and  it 
gradually  took  the  place  of  the  Arabic  literature,  its  degenerate  daughter. 


MEDICAL  ORGANIZATION.  379 

Soon  the  monuments  of  antique  science  were  insufficient  for  the  expand- 
ing human  mind.  They  were  submitted  to  a  criticism  more  clairvoyant 
and  severe,  which  revealed  many  defects,  and  weakened  very  much  the 
respect  in  which  these  precious  relics  had  been  held.  Then  adventurous 
and  impatient  minds  attempted  to  overturn  the  entire  edifice  of  human 
acquirements,  and  rebuild  it  in  a  day ;  but  their  work — fruit  of  a  mor- 
bidly excited  imagination,  having  neither  reason  nor  experience  to  sus- 
tain it — fell  before  the  light  of  discussion,  as  the  dreams  of  an  unquiet 
night  fly  at  the  approach  of  day.  A  few  men,  however,  succeeded  in 
uniting  the  worship  of  antique  traditions  with  the  love  of  novelties ; 
they  comprehended  that  to  reform  was  better  than  to  destroy,  and  that 
all  change  is  justifiable  only  as  it  includes  a  progress  and  an  ameliora- 
tion. Consequently,  they  contented  themselves  with  proposing  partial 
modifications  of  the  ancient  doctrines,  with  a  view  to  improve,  not  to 
<lestroy  them. 


380  REFORM   PERIOD. 


VIII.    REFOEM   PERIOD. 

COMPEISING  THE  SEVENTEENTH  AND  THE    EIGHTEENTH    CENTURIES. 
GENERAL     CONSIDERATIONS. 

We  have  just  seen  the  systems  of  Aristotle  and  Galen  resist  the 
premature  attacks  of  the  partisans  of  the  occult  sciences,  and  gather 
around  them  the  great  majority  of  minds,  by  means  of  some  partial 
modifications  claimed  by  the  less  bold  though  more  sensible  innovators. 
The  long  duration  of  these  systems,  the  almost  unanimous  accord  of  the 
great  men  of  antiquity  and  of  the  middle  ages,  in  their  favor,  formed  a 
precedent  so  respectable  that  a  general  disposition  to  disdain  them  had 
not  yet  been  learned.  It  is  not  then  astonishing  that  the  most  eminent 
men  in  science  should  prefer  them  to  the  eccentric  and  mal-elaborated 
theories  of  the  founders  of  the  occult  doctrines — to  those  of  restless, 
capricious,  and  haughty  minds,  who  pretended  to  arrogate  to  themselves 
the  sceptre  of  knowledge,  without  taking  the  trouble  to  prepare  a  scien- 
tific reform  whose  wisdom  and  greatness  would  justify,  in  the  eyes  of 
enlightened  men,  so  high  a  pretension. 

In  the  meantime  the  domain  of  natural  sciences  enlarged  from  day  to 
day ;  observation  had  enriched  it  with  a  multitude  of  new  facts  which 
harmonized  with,  or  discredited  prevailing  doctrines.  The  moment 
approached  when  the  need  of  a  radical  reform  was  felt  in  nearly  every 
branch  of  human  science.  Men  whose  knowledge  equaled  their  genius, 
began  to  appear  and  take  the  direction  of  the  intellectual  movement, 
and  substitute  for  the  decrepid  theories  of  the  schools,  those  which  were 
younger,  stronger,  and  harmonized  better  with  the  totality  of  known 
phenomena.  The  worship  of  the  ancients  is  succeeded  by  an  immode- 
rate desire  to  shake  off  their  yoke,  and  to  revenge  in  some  sort  their 
■long  tyranny.  On  this  account  I  have  given  to  this  the  name  of  Eeform 
Period,  which  characterizes  perfectly,  if  I  am  not  mistaken,  the  gene- 
ral tendency  of  minds,  the  predominant  thought  and  culminating  fact 
'Of  the  epoch. 


i 


GENERAL    CONSIDERATIONS.  381 

At  the  beginning  of  this  period  a  Florentine  nobleman,  one  of  the 
fioest  geniuses  of  modern  times,  Vincent  Galileo,  carried  the  torch  of 
regeneration  in  physics.  Without  other  guide  than  his  intelligence  he 
abandoned  the  route  of  subtile  speculation  to  follow  that  of  observation 
only.  In  this  way  he  reaped  an  ample  harvest  of  surprising  truths,  one 
of  which  would  suffice  to  immortalize  his  name.  He  first  calculated  the 
law  of  gravity;  he  discovered  the  weight  of  the  atmosphere,  and  he 
asserted  the  movement  of  the  earth  on  its  own  axis  and  around  the  sun. 
Nothing  was  wanting  to  his  glory,  not  even  the  seal  of  persecution.  He 
was  cast  into  the  dungeons  of  the  holy  inquisition,  for  creating  too  daz- 
zling a  light  before  the  eyes  of  his  cotemporaries.  At  the  same  time 
Kepler  traced  the  course  of  the  heavens  for  Newton,  by  his  bold  and 
happy  hypotheses. 

While  the  astronomers,  extending  the  limits  of  the  universe,  and  with- 
out pretending  to  read  in  the  stars,  as  the  astrologists,  the  destiny  of 
kings  and  of  nations,  determined  with  a  marvelous  exactitude  the  laws 
which  maintain  harmony  in  the  movements  of  these  sublime  bodies,  the 
naturalists  discovered  by  the  aid  of  the  microscope,  a  new  world  close 
by  us,  under  our  hands,  which  the  ancients  had  not  even  suspected. 
Their  eye  perceived  in  a  drop  of  liquid  myriads  of  organised  beings, 
living  and  moving  in  the  narrow  space,  as  in  the  midst  of  an  immense 
lake.  The  chemists,  abandoning  the  vain  and  darkened  researches  of 
alchymy,  reaped  on  their  part  an  ample  harvest  of  useful  and  unheard  of 
discoveries.  In  place  of  reasoning  theoretically,  after  the  manner  of  the 
philosophers,  on  the  nature,  form  and  combinations  of  the  material  ele- 
ments, they  studied  every  thing  experimentally  ;  they  learned  to  modify 
and  overcome  them  at  pleasure — in  short  they  endowed  man  in  some 
degree  with  a  secondary  creative  power.  The  ancient  philosophers  had 
no  more  rude  adversaries  than  they,  and  their  labors  contributed  more 
to  destroy  their  dogmas  than  those  of  any  other  class  of  savans.  Bernard 
Palissy,'-'-  a  simple  potter  of  Agen,  and  Andrew  I.ibavius,  doctor  in  medi- 
cine, native  of  Halle,  in  Saxony,  were,  during  the  sixteenth  century,  the 
true  princes  of  chemistry,  the  precursors  of  the  experimental  doctrine  of 
Chancellor  Bacon. 

Medicine  made  also,  at  the  same  time,  numerous  and  great  conquests, 
which  led  to  frequent  revolutions  in  its  theory.  The  truth  of  that 
aphorism,  ''  experience  is  decej)tive,  and  judgment  difficidt,''^  was  never 
more  evident  than  during  this  period,  in  which  we  see  melt  away,  not 
only  Galenism,  but  also  several  other  newly  hatched  systems,  all  of 
which  had  had  the  pretention  of  being  founded  in  experience,  and 

"See  (Euvres  de  Bernard  Palissy,  by  M.  Cap,  Paris  184:3,  12mo. 


382  REFORM    PERIOD. 

had  been  emitted  and  extolled  by  men  of  superior  merit.  "But,  as  will 
appear  in  the  course  of  this  history,  all  these  systems  had  the  defect  of 
considering  the  phenomena  of  the  animal  economy  in  one  aspect  only, 
and  neglecting  others  not  less  important.  All  committed  the  no  less 
grave  error  of  passing,  in  their  abstractions,  beyond  the  limits  of  sensible 
phenomena.  For  this  reason  they  have  all  vanished,  or  suffered  great 
modifications,  after  an  existence  more  or  less  ephemeral. 

We  proceed  now,  according  to  our  custom,  to  expose,  in  the  first 
place,  the  material  progress  in  each  principal  branch  of  the  science,  and 
then  the  varieties  of  the  most  important  doctrines.  Nevertheless,  it 
will  happen  more  than  once,  as  has  already  frequently  occurred,  that 
after  having  reported  a  fact,  or  an  observation,  we  shall  join  it  at  once 
to  some  theory ;  because  it  is  sometimes  impossible,  or  at  least  very 
inconvenient,  to  separate  from  a  phenomenon  its  theoretical  explanation. 


CHAP  TEE    I, 

ANATOMY    AND    PHYSIOLOGY. 

The  anatomists  of  the  sixteenth  century  had  described  the  apparent 
and  easily  accessible  parts  of  the  human  body  with  such  scrupulous  exact- 
ness, that  they  had  left  little  for  their  successors  to  do  in  this  particu- 
lar ;  consequently,  the  latter  turned  their  attention  in  another  direction. 
Minute  and  comparative  anatomy,  and  experimental  physiology,  offered 
a  vast  field  of  new  truths,  till  now  but  little  explored.  They  directed 
their  observations  toward  these  objects,  and  their  efforts,  as  we  shall 
see,  were  crowned  more  than  once  with  brilliant  success. 

OmCULATION   OF   THE   BLOOD. 

Before  describing  the  researches  which  have  immortalized  the  name 
of  William  Harvey,  it  will  be  proper  to  recall,  succinctly,  what  were 
the  acquisitions  of  his  predecessors,  on  this  function  of  the  animal 
economy. 

The  liver  was  considered,  from  time  immemorial,  as  the  organ  of 
sanguification.  It  was  supposed  that  the  veins  took  their  origin  in  this 
viscus,  and  that  they  were  the  sole  order  of  vessels  that  contained, 
naturally,  the  blood.  It  was  imagined  that  the  fluid  flowed  from  its 
principal  reservoir  to  all  parts  of  the  body,  and  returned  to  its  source 
through  the  same  canals,  by  an  undulating  movement,  similar  to  the 
flux  and  reflux  of  the  sea.     The  arteries  were  supposed  to  contain,  in 


ANATOMY  AND   PHYSIOLOGY.  383 

their  normal  state,  vital  spirits  only,  of  which  the  heart  was  the  great 
reservoir  ;  but  it  was  admitted  that  in  certain  diseases,  the  blood  could 
make  an  irruption  into  the  arterial  channels.  Such  was  the  doctrine 
of  the  Asclepiada?,  and  particularly  of  Erasistratus. 

Galen  modified  it  by  demonstrating  that  the  arteries  contained  blood, 
at  every  period  of  life.  Neither  was  he  ignorant  that  this  li(£uid  is 
poured  into  the  right  cavities  of  the  heart  by  the  great  veins  ;  but  he 
believed  that  only  a  small  quantity  passed  from  the  right  ventricle 
into  the  lungs,  by  means  of  the  pulmonary  artery,  while  the  major 
part  came  directly,  according  to  him,  to  the  left  ventricle,  by  passing 
through  the  porosities  of  the  interventricular  septum.  This  opinion  of 
Galen  was  uncontested  till  the  middle  of  the  sixteenth  century. 

At  that  epoch  the  theologian  Michael  Servetus,  the  same  who  perished 
a  victim  of  the  jealousy  of  Calvin,  dared  to  deny  the  passage  of  the 
blood  through  the  septum  of  the  ventricles.  He  contended  that  the 
blood  which  comes  into  the  right  cavities  of  the  heart,  passed  by  the 
pulmonaiy  artery  to  be  distributed  in  the  lung,  whence  it  returned  into 
the  left  ventricle,  by  the  pulmonary  veins.  This  was  a  luminous 
thought,  and  a  great  step,  in  fact,  toward  the  truth.  Shortly  after. 
li.  Columbus  demonstrated,  anatomically,  the  conjecture  of  Servetus, 
by  showing  the  real  use  of  the  valves  of  the  heart. 

A.  Cesalpin  approached  still  nearer  the  truth.  He  explained,  in  the 
game  manner  as  Columbus,  the  course  of  the  blood  through  the  lungs, 
and  added,  that  the  last  arterial  ramifications  communicated  with  the 
veins — that  the  blood  and  vital  spirits  passed  from  the  arteries  into  the 
veins  during  sleep,  which  seems  to  him  j^roven  by  the  swelling  of  the 
veins  and  the  diminution  of  the  pulse,  at  that  time. 

They  knew,  also,  the  existence  of  valves  in  the  veins.  It  was  dem- 
onstrated by  experiment,  that  if  an  artery  is  tied,  on  a  living  animal,  the 
blood  ceases  to  flow,  and  pulse  stops  below  the  ligature  ;  but  if,  on  the 
contrary,  a  vein  was  tied,  it  shrunk  above  the  ligature,  and  tumefied 
below  it.  Such  was  the  state  of  science  at  the  beginning  of  the  seven- 
teenth century.  There  was  only  one  step  to  take  to  find  the  true  course 
of  the  blood,  but  that  step  was  difficult,  as  we  may  now  readily 
understand. 

William  Harvey,  native  of  Folkstone,  in  the  county  of  Kent,  made 
his  first  studies  in  his  own  country.  Afterward,  he  traveled  for  his 
instruction,  in  France,  Germany,  and  Italy,  and  remained  at  Padua 
during  four  years,  to  hear  the  lectures  of  Fabricius  d'Aquapendente. 
He  returned  to  his  country  with  the  title  of  Doctor,  in  1602,  and  estab- 
lished himself  in  London,  and  was  elected  sometime  afterward,  a  mem- 
ber of  the  College  of  Medicine.     Named  regent  in  1013,  he  commenced 


384  REFORM   PERIOD. 

to  make  known  his  doctrine  on  the  circulation  of  the  blood,  in  his  public 
lectures,  but  he  did  not  publish  the  result  of  his  researches  till  1G28, 
after  having  submitted  them  for  fifteen  years  to  proofs  and  counter 
proofs  of  every  kind. 

Here  is  his  own  story,  in  which  he  depicts  the  obstacles  he  met  with 
in  his  efforts  to  discover  the  truth :  "Devoting  myself  to  discern  the 
use  and  utility  of  the  movements  of  the  heart  in  animals,  in  a  great 
number  of  vivisections,  I  found  at  first  the  subject  so  full  of  difficulties 
that  I  thought,  for  a  long  time,  with  Fracastor,  that  the  secret  was 
known  to  God  alone.  I  could  distinguish,  neither,  in  what  manner  the 
systole  and  dioistole  took  place,  nor  at  what  moment  the  dilatation  and 
constriction  occurred,  owing  to  the  celerity  of  the  movements  of  the 
heart,  which,  in  most  animals,  is  executed  in  the  twinkling  of  an  eye, 
or  like  the  flash  of  lightning.  I  floated,  undecided,  without  knowing  on 
what  opinion  to  rest.  Finally,  from  redoubled  care  and  attention,  by 
multiplying  and  varying  my  experiments,  and  by  comparing  the  various 
results,  I  believed  I  had  put  my  finger  on  the  truth,  and  commenced 
unraveling  the  labyrinth.  I  believed  I  had  seized  the  correct  idea  of 
the  movement  of  the  heart  and  arteries,  as  well  as  their  true  use. 
From  that  time  I  did  not  cease  to  communicate  my  views  either  to  my 
friends,  or  to  the  public  in  my  academical  course."'-' 

M.  Dezeimeris  appreciates  as  follows  the  discovery  of  the  English 
physiologist:  "  To  its  intrinsic  merits,  the  work  of  Harvey  on  the  cir- 
culation of  blood  has,  besides,  the  merit  of  arrangement.  The  author  first 
clears  up  his  course,  by  removing  the  errors  of  antiquity  ;  he  describes, 
next,  the  movements  of  the  heart  in  the  living  animal,  he  shows  its 
muscular  structure,  the  alternate  contractions  of  the  auricles  and  ven- 
tricles, the  influence  they  must  exert  to  drive  the  blood  with  force  into 
the  arteries,  determined  in  that  direction  by  the  mechanism  of  the 
valves  ;  in  fine,  he  establishes  the  whole  system  of  the  circulation.  He 
terminates  the  treatise  by  original  observations  on  the  difierence  of  its 
structure,  in  different  animals,  at  different  periods  in  life."f 

So  much  care  and  circumspection  in  the  research  for  truth,  so  much 
modesty  and  firmness  in  his  demonstration,  so  much  clearness  and 
method  in  the  development  of  his  ideas,  should  have  prepossessed  every 
one  to  favor  the  theory  of  Harvey ;  but,  on  the  contrary,  it  caused  a 
general  stupefaction  in  the  medical  world,  and  gave  rise  to  much  oppo- 
sition. This  theory,  which  appears  to  us  to-day  so  natural  that  we  con- 
ceive with  difficulty  why  it  was  not  found  much  sooner,  was  nothing 

'"'Guillelmi  Harvey,  Exercitatio  Anatomica  de  Cordis  et  Sanguinis  mo tu,  cap.  i. 
f  Dictionaire  Historique  de  Medicine,  at  the  word  Haevey. 


ANATOMY    AND   PHYSIOLOGY.  385 

less  than  a  revolution  in  physiology.  I  shall  not  pause  to  describe  all 
the  phases  of  the  controversy  it  excited ;  it  will  be  sufficient  to  say  that 
it  continued  no  less  than  twenty-five  years,  and  that  there  was  not  a 
man  at  the  time  who  made  any  pretension  to  a  knowledge  of  anatomy 
and  physiology,  who  did  not  take  an  active  part  in  it.  Even  the  natu- 
ralists and  philosophers  themselves,  did  not  remain  indifferent.  Eene 
Descartes  was  one  of  the  first  to  declare  himself  in  favor  of  the  new 
doctrine  of  the  circulation,  and  supported  it  by  some  experiments,  but 
especially  by  the  authority  of  his  name.  John  Waloeus,  a  celebrated 
anatomist,  and  professor  in  the  University  of  Leyden,  confirmed  it  by 
new  observations.  Finally,  Plempius,  of  Louvaine,  one  of  the  most 
fiery  adversaries  of  this  theory,  gave  way  to  the  force  of  truth,  and 
passed  with  a  free  will  and  publicly  over  to  the  ranks  of  its  defenders, 
in  1652.  This  was  a  great  triumph  for  Harvey,  and  brought  so  much 
additional  support  to  his  doctrine  as  nearly  to  silence  all  02)position. 

During  these  long  debates  the  conduct  of  Harvey  was  always  digni- 
fied and  firm.  He  mingled  in  the  polemic  which  his  discoveries  had 
excited,  only  to  add  new  proofs  and  new  experiments  to  those  he  had 
already  published.  One,  only,  of  his  adversaries  obtained  a  direct  re- 
sponse from  him.  This  was  John  Eiolan,  professor  in  the  faculty  of 
Paris,  and  one  of  the  greatest  anatomists  of  his  age.  Harvey  attached 
much  value  to  his  support.  In  seeking  to  convince  him,  he  spoke 
always  with  the  greatest  deference,  giving  him,  several  times,  the  epi- 
thet of  prince  of  the  Science.  The  opinion  of  J.  Ptiolan  was,  in  fact, 
of  immense  weight  among  his  cotemporaries ;  but  whether  from  excess 
of  respect  for  the  ancients,  or  from  envy  against  moderns,  he  combatted, 
with  as  much  violence  as  obstinacy,  the  two  finest  discoveries  of  the  age, 
namely,  that  of  Harvey,  and  that  of  Pecquet,  which  we  shall  soon 
consider.-' 

Harvey  had  the  satisfaction  before  his  death,  to  see  his  theory  of  the 
movements  of  the  heart  and  of  the  blood  universally  adopted.  He  left, 
besides,  interesting  observations  on  generation,  in  man  and  in  animals — 
on  midwifery — and  on  the  structure  and  diseases  of  the  uterus. 

The  further  progress  of  science  only  confirmed  the  doctrine  of  the  circu- 
lation of  the  blood.  In  1 G  6 1 ,  Malpighi,  professor  at  Bologna,  demonstrated 
for  the  first  time,  by  the  aid  of  the  microscope,  the  progression  of  the 
blood  globules  in  the  small  vessels.  He  confirmed  the  reality  of  the 
communication  which  had  been  said  to  exist  between  the  arteries  and 
the  veins,  and  gave  a  clear  demonstration  of  their  last  branches.  In 
1690,  Anthony  de  Leeuwenhoek,  naturalist  of  Delft,  was  enabled  to  see, 

^  See  Lettres  de  Gui  Patin,  new  edition,  with  notes  by  M.  Reveille.  Paris. 


386  REFORM   PERIOD. 

with  bis  perfected  microscope,  the  movements  of  the  blood  in  the  small- 
est vessels,  and  gave  to  several  persons  important  testimony  of  his 
observations. 

Leaving  far  in  the  rear  his  precursors,  E.  Lower  and  J.  M.  Lancisi, 
J.  Senac  published  in  1749,  his  great  work  on  the  Structure  of  the 
Heart,  its  Actions  and  Diseases.  The  author  puts  forth,  in  his  preface, 
some  maxims  of  medical  philosophy  stamped  with  wisdom,  among  which 
we  find  the  following :  "  Theory  reduced  to  consequences  drawn  from 
facts  alone,  is  the  light  of  practice.  But  in  following  the  track  of 
nature  by  the  light  of  experiments  and  observation,  we  soon  arrive  at  the 
barriers  where  the  mind  is  abandoned  to  itself.  In  going  beyond 
these  limits,  it  can  rest  only  on  conjectures,  where  error  is  inevitable." 
*'  While  some  elevated  the  force  of  the  heart  to  a  weight  of  three  mil- 
lions of  pounds,  others  reduced  it  to  the  weight  of  eight  ounces.  A  rival 
of  Newton  and  Leibnitz  (M.  d'Alembert),  was  more  wise,  who  said  that 
none  but  the  foolish  attempted  to  estimate  the  force  of  the  heart's 
action.""  Notwithstanding  this  severe  criticism  given  against  those 
who  attempted  to  calculate  the  vital  forces,  Senac,  in  the  course  of  his 
work,  gives  a  conjecture  on  this  subject.  Having  remarked  that  a 
weight  of  fifty  pounds,  attached  to  the  foot,  was  raised  by  the  pulsation 
of  the  artery,  he  estimated,  approximately,  the  force  of  the  heart  at  two 
hundred  pounds. 

He  describes  with  much  care,  the  structure  of  the  heart,  and  the 
direction  of  its  fibres,  of  which  the  external  appeared  to  him  oblique, 
and  the  internal  arranged  in  spiral.  These  latter  take  their  origin, 
according  to  him,  from  the  fleshy  columns  of  the  aortic  ventricle.  He 
placed  among  the  remote  causes  of  the  movements  of  the  heart,  the 
animal  spirit,  which  is  transmitted  from  the  brain  and  the  spinal  marrow, 
to  the  muscle,  by  the  intermediation  of  the  nerves.  This  spirit,  he 
thought,  was  a  fluid  extremely  elastic,  which  the  impression  of  the  blood 
on  the  delicate  tissue  of  the  parietes  and  columns,  put  in  action.  In 
the  first  place,  the  vena  cava,  by  these  alternate  constructions,  caused 
the  blood  to  enter  into  the  auricles,  which,  stimulated  by  the  presence 
of  that  liquid,  contract,  in  their  turn,  and  push  it  into  the  ventricles. 
These  last  commence  at  once  to  act,  and  drive  forward  the  blood  which 
they  contain.  Thus,  these  three  machines,  by  the  aid  of  the  fluid 
which  they  enclose,  act  successively,  while  the  vital  spirit  subsists  in 
the  tissue  of  the  brain  and  nerves.  The  heart  is  only  the  prime  mover, 
or  determining  and  conditional  cause  of  the  movement  of  the  blood,  but 

*  Traite  de  la  Structure  de  Cceur,  de  son  Action  de   ses  Malacies,  11.  edition ; 
published  by  A.  Portal,  Paris,  1774,  T,  I.,  preface,  p.  32. 


ANATOMY  AND   PHYSIOLOGY.  387 

its  force  is  insufficient  to  produce  it  alone ;  we  must  add  to  it  the  elas- 
ticity of  the  arterial  coats,  and  above  all  the  action  of  their  muscular 
fibres  and  their  nerves.  In  regard  to  the  pathology  of  the  central  organ 
of  the  circulation,  which  forms  the  last  part  of  the  treatise,  we  will  say 
simply,  that  diagnosis,  in  it,  is  carried  to  as  high  a  degree  of  perfection 
as  could  be  attained  prior  to  the  discovery  of  percussion  and  ausculta- 
tion.-' This  work,  in  which  analysis  was  pushed  to  its  utmost  limits, 
made  a  sensation  in  the  medical  world.  His  cotemporaries  spoke  of  it 
only  in  terms  of  admiration.  Morgagni,  when  refering  to  it,  applies  to 
the  author  the  epithet  of  great ;  but  it  has  become  much  out  of  date 
since  the  perfection  of  auscultation  and  percussion  has  carried  the 
diagnosis  in  thoracic  diseases  to  an  unhoped  for  success.  Senac  was 
physician  to  Louis  XIV.,  after  Chicoyneau,  and  he  had  the  entire  confi- 
dence of  his  sovereign. 

ON  EESPIRATION. 

If  the  researches  concerning  the  mechanism  and  end  of  respiration, 
^ve  not  results  as  prompt  and  decisive  as  those  relative  to  the  circula- 
tion of  the  blood,  they  were  not,  however,  unfruitful,  as  is  very  plain  in 
comparing  the  notions  which  antiquity  has  transmitted  to  us  on  this  sub- 
ject, with  those  that  were  possessed  at  the  close  of  the  last  century. 

The  ancient  anatomists  described,  summarily,  the  exterior  form  of  the 
lungs,  their  situation  in  the  thoracic  cavity,  their  spongy  consistency,  as 
well  as  the  cartilagino-membranous  structure  of  the  trachea,  and  the 
first  divisions  of  the  bronchia ;  they  did  not  carry  farther  their  dissec- 
tions, but  they  thought  that  the  extremities  of  the  bronchia  anasta- 
mised  with  the  radicals  of  the  pulmonary  veins,  which  they  named  on 
that  account,  arterial  veins :  that  is  to  say,  veins  conducting  the  atmos- 
pheric fluid  of  the  lungs  into  the  heart. 

On  these  vague  and  partly  erroneous  anatomical  data,  they  built  the 
following  theory :  The  air  drawn  into  the  lungs  by  the  heat  of  the  heart, 
the  reservoir  of  the  vital  spirits,  enters  by  the  trachea  and  bronchia. 
In  penetrating  into  the  last  bronchial  ramifications,  it  is  rarified :  the 
thinnest  part  passes  into  the  pulmonary  veins,  to  be  carried  to  the  heart, 
where  it  serves  as  material  for  the  fabrication  of  the  vital  spirit :  its 
grosser  parts  were  exhaled  with  the  fuliginosities  of  the  heart,  during 
expiration.  According  to  this  theory,  respiration  had  two  purposes — 
one  to  refresh  the  lung,  which  being  of  a  porous  and  inflamablc  nature, 
would  be  in  danger,  without  it,  of  taking  fire  by  the  contact  of  the 
heart — the  focus  of  animal  heat ;  the  other  to  furnish  the  pneuma  or 

*  As  it  is  no  part  of  my  plan  to  enter  into  any  account  of  these  important  dis- 
coveries in  science,  I  refer  the  reader  to  the  treatisis  of  Laaennec  and  Bouillaud. 


388  REFORM   PERIOD. 

ether,  whicTi  was  employed  by  the  heart  in  the  fabrication  of  animal 
spirits.  Such  were  the  ideas  formed  on  the  mechanism  and  end  of  the 
respiratory  function — ideas  which  reigned,  without  submitting  to  any 
important  modification,  down  to  the  seventeenth  century. 

The  discovery  of  the  small  and  great  circulation  sapped  one  of  the 
bases  of  this  theory,  for  they  showed  that  the  pulmonary  veins  carried 
to  the  heart  no  other  li({uid  than  the  blood,  and  that  no  substance, 
liquid  or  gaseous,  could  re-flow  from  the  aortic  cavities  into  the  lung. 
In  1661,  Malpighi  demonstrated  the  cellular  structure  of  this  viscus. 
He  announced  that  the  bronchial  ramifications  terminated  in  vesicules 
lined  by  a  vascular  rete,  and  communicated  with  each  other. 

About  this  time  much  more  careful  examinations  were  instituted  than 
bad  ever  been  before,  in  regard  to  the  manner  in  and  forces  by  which  the 
movements  of  the  chest  are  efi'ected.  J.  A.  Borelli,  Adrian  Helvetius, 
and  many  others,  among  whom  the  indefatigable  A.  Haller  holds  the 
first  rank,  made,  on  the  same  subject,  interesting  experiments,  which 
may  be  summed  up  as  follows :  First,  during  inspiration  the  thoracic 
cavity  is  enlarged  in  all  respects,  by  the  action  of  the  diaphragm  and 
intercostal  muscles,  aided  occasionally  by  the  action  of  the  muscles 
which  extend  the  neck,  the  shoulders,  and  the  head — in  short,  of  the 
superior  regions  of  the  chest.  Secondly,  in  expiration,  this  same  cavity 
diminishes  by  the  simple  relaxation  of  the  inspiratory  muscles.  Ordi- 
narily this  relaxation  is  sufficient  to  enable  the  thorax  to  diminish,  and 
return  upon  itself.  In  other  cases,  the  triangular  muscle  of  the  sternum, 
the  abdominal,  the  dorso-lumbar,  in  a  word,  all  the  muscles  that  connect 
the  parietes  of  the  thorax  to  the  inferior  regions  of  the  trunk,  excepting 
the  diaphragm,  concur  to  produce  the  expiratory  movement.  Thirdly, 
there  never  exists  an  empty  space  between  the  lungs  and  the  side  of 
the  chest.  The  pulmonary  organ  follows  the  cavity  which  incloses  it — 
it  dilitates  when  it  expands,  and  diminishes  when  it  contracts.  Fourthly, 
the  air  is  not  drawn  into  the  chest  by  the  heat  of  the  parts,  but  by 
the  tendency  of  all  gaseous  fluids,  to  maintain  an  equilibrium.  When 
the  thoracic  cavity  is  expanded  by  the  action  of  the  inspiratory  muscles, 
the  air  which  it  contains  becomes  rarified,  and  is  no  longer  in  equi- 
librium with  the  external  air.  which  rushes  in  through  the  opening  of 
the  trachea.     This  is  the  mechanism  of  respiration. 

That  being  settled,  difi'erent  pneumatic  theories  were,  by  turns,  adopted 
and  abandoned.  Here  is  one  of  the  most  remarkable :  the  latro- 
mechanicians  assumed,  that  in  respiration  no  particle  of  air  penetrates 
into  the  blood,  but  that  the  alternate  movements  of  the  expansion  and 
contraction  of  the  chest  have  the  efl^ect  of  l)reaking  and  attenuating  the 
molecules  of  the  venous  fluid,  and  mingling  them  with  the  lymph  and 


ANATOMY   AND   PHYSIOLOGY.  389 

the  chyle,  and  changing  thus  the  venous  into  arterial  blood.  Besides, 
they  thought  that  the  unfolding  of  the  pulmonary  vessels,  during 
inspiration,  favors  the  passage  of  the  blood  through  the  lungs. 

Some  physicians  renewed  the  theory  of  the  ancients,  in  modifying  it  ; 
they  thought  that  the  air  inspired,  being  colder  than  that  which  is 
expired,  serves  to  moderate  the  heat  of  the  heart,  and  the  effervescence 
of  the  constituent  parts  of  the  blood ;  that  the  impression  of  the  cold 
air  against  the  parietes  of  the  pulmonary  vessels  serves  to  condense 
the  venous  blood,  and  changes  it  into  red  blood,  without  the  addition  of 
any  new  principle. 

All  these  theories  had  to  give  way  before  the  exact  knowledge  of  the 
changes  that  occur  in  the  atmosphere  during  respiration.  It  was 
ascertained  by  rigorous  experiments,  that  the  air  which  enters  into  the 
che.st  has  lost,  when  it  passes  out,  a  portion  of  its  oxygen,  which  is 
replaced  by  a  nearly  equal  quantity  of  carbonic  acid  and  aqueous 
vapor.  These  phenomena,  which  had  been  conceived  by  Mayow,  in 
1668,  were  perfect!}^  established  by  subsequent  observations.  It  had 
always  been  observed  that  the  blood  which  appears  black  in  issuing 
from  the  vein,  in  phlebotomy,  becomes  red  in  contact  with  the  air.  In 
fine,  direct  observation  proved  that  a  similar  change  of  color  takes  place 
in  the  blood,  in  its  passage  through  the  pulmonary  vessels  during  life. 
Goodwin  was  the  first,  who,  having  opened  the  thorax  of  a  frog,  saw  the 
sanguineous  fluid,  which  came  black,  and  in  appearance  venous,  to  the 
lung,  acquire  a  fine  red  color  in  traversing  the  tissue  of  the  organ. 
Hessenfratz  filled  a  soaked  bladder  with  venous  blood,  and  plunging 
this  membranous  pouch  into  an  atmosphere  of  oxygen  gas,  saw  the  blood 
change  from  black  to  red.-' 

Toward  the  close  of  the  eighteenth  century,  Lavoisier,  resting  on  the 
facts  we  have  just  named,  proposed  a  pneumatic  theory  of  seducing 
simplicity:  "When  the  atmospheric  fluid,"  says  the  celebrated  chemist, 
"has  reached  the  pulmonary  vesicles,  a  poi'tion  of  its  oxygen  passes  the 
extremely  delicate  walls  of  these  vesicles  and  combines  with  the  excess 
of  carbon  and  hydrogen  of  the  venous  blood,  to  form  the  carbonic  acid 
and  acqueous  vapors  which  are  found  in  the  expired  air.  The  venous 
fluid,  thus  freed  from  its  excess  of  carbon  and  hydrogen,  acquires, 
instantly,  that  fine  red  tint  which  characterises  the  arterial  blood,  and 
constitutes,  according  to  the  views  of  many  physiologists,  hsematosis. 

The  respiratory  function  was  assimilated,  by  this  theory,  to  the  com- 
bustion of  a  lamp,  in  which  the  carbon  and  hydrogen  of  the  oil,  by 

'-■  I  say  nothing  yet  of  the  experiments  of  Bichat,  which  belong  to  the  nineteenth 
century,  by  the  date  of  their  publication. 


390  REFORM    PERIOD. 

combining  witli  the  oxygen  of  the  air,  produce  carbonic  acid  and  vaj3or. 
During  this  double  combination,  there  is  evolved  a  great  quantity  of 
caloric,  which  Lavoisier  regarded  as  the  source  of  animal  heat.  A  some- 
what general  law  in  zoology  seemed  to  confirm  this  interpretation.  It 
had  been  observed  that  among  animals  provided  with  lungs,  the  natural 
temperature  is  so  much  the  more  elevated  as  the  respiratory  apparatus  has 
extent,  and  as  they  absorb  a  greater  quantity  of  air. 

The  purely  chemical  theory  of  Lavoisier  was  received  with  enthusiasm 
by  the  learned  world.  It  seemed  to  shed  a  clear  light  on  two  great 
phenomena  of  the  animal  economy — hsematosis  and  calorification — of 
which  no  one  had  before  given  any  satisfactory  explanation.  Xeverthe- 
less,  it  was  soon  perceived  that  it  was  subjected  to  very  grave  objections, 
two  of  which,  for  the  present,  we  will  give.  If  it  is  true,  said  one, 
that  the  lung  is  the  focus  of  all  the  animal  heat,  its  temperature  should 
be  much  more  elevated  than  that  of  the  other  viscera,  which  observation 
does  not  show  ;  on  the  contrary,  all  experiments  show  that  the  tempera- 
ture of  the  lungs  does  not  difi'er  sensibly  from  that  of  other  organs  ; 
secondly,  in  this  theory  are  set  aside  both  the  action  of  the  lung  proper, 
and  of  the  nervous  influence — an  influence  which  might  have  been 
inferred,  a  priori,  and  whose  existence  was  put  beyond  doubt  by  subse- 
quent and  conclusive  experiments.-' 

LYMPHATIC     SYSTEMS. 

The  discovery  of  the  lymphatic  vessels  and  their  functions,  was  no 
less  remarkable  than  that  of  the  circulation  of  tlie  blood.  If  it  had  less 
eclat,  it  is  because  it  was  not,  as  the  former,  the  work  of  one  man,  but 
its  complete  development  took  place  only  by  a  slow  gradation.  Our 
mind,  like  our  eye,  is  strikingly  impressed  only  when  the  light  reaches 
it  suddenly. 

It  appears  that  Herophilus  and  Erasistratus  had  perceived  in  the 
mesentery  of  some  animals,  white  vessels,  which  were  connected  with 
the  mesenteric  glands.  They  took  them  to  be  arteries,  full  of  air. 
G-alen,  who  had  an  opportunity  of  seeing  them,  treated  their  remarks  as 
chimerical.  He  believed  that  the  veins  of  the  mesentery  absorbed  the 
chyle  in  the  intestines,  and  carried  it  to  the  liver,  where  it  was  trans- 
formed into  blood.  This  opinion  reigned  until  the  middle  of  the 
seventeenth  century.  However,  as  early  as  the  year  1563,  Eustachius 
had  described  the  thoracic  duct  of  a  horse,  but  did  not  suspect  its  use. 
In  1622,  Gaspard  Aselli,  professor  of  anatomy  at  Milan,  discovered  the 

"  See  researches  of  Dupuytren,  Ch.  Dumas,  M.  Blainville,  and  others,  on  the 
effects  of  the  section  of  the  pneumogastric  nerves. 


ANATOMY   AND    PHYSIOLOGY.  391 

lacteal,  or  chyliferous  vessels,  on  a  dog  which  was  killed  immediately 
after  eating,  for  purposes  of  dissection.  Accident  led  him  to  this 
discovery,  according  to  his  own  account,  which  is  as  follows:  "I  per- 
ceived," he  says,  "  on  the  walls  of  the  intestines  and  in  the  folds  of  the 
mesentery,  very  fine  white  filaments,  which  I  took  at  first  to  be  nervous 
filaments ;  but  having  pricked  one  by  mistake,  I  saw  issue  from  it  a 
white,  creamy  liquid.  Struck  with  astonishment,  I  took  pains  to  estab- 
lish this  unexpected  phenomenon  before  the  eyes  of  spectators,  among 
whom  there  were  two  very  distinguished  physicians,  Louis  Settala  and 
Alexander  Taddini." 

On  the  following  days,  Aselli  repeated  the  same  experiment  on  other 
dogs,  with  equal  success,  and  acquired  the  certainty  that  the  white 
threads  were  vessels  which  drew  the  chyle  from  the  intestines.  He 
observed  the  valves  with  which  they  are  supplied,  but  supposed  that 
they  all  met  in  the  pancreas,  to  be  continued  to  the  liver,  which  has 
always  been  regarded  as  the  organ  of  sanguification. 

finally,  in  1647,  John  Pecquet,  being  still  a  student  at  Montpelier, 
discovered  the  reservoir  that  bears  his  name,  and  which  is  formed  by 
the  union  of  all  the  lymphatic  trunks  of  the  inferior  members,  and 
those  of  the  organs  contained  in  the  abdominal  cavity.  ••■^  This  reservoir, 
situated  between  the  second  and  third  lumbar  vertebrge,  is  the  beginning 
of  the  thoracic  canal,  which  is  varied  in  structure,  sometimes  straight, 
again  flexed,  sometimes  single,  and  sometimes  double,  lying  along  the 
anterior  face  of  the  dorsal  column,  and  empties  itself  into  the  left  sub- 
clavian vein.  Pecquet  followed  the  canal  to  its  termination.  Having 
ligated  it,  he  saw  it  swell  below  and  empty  itself  above  the  ligature. 
He  studied  with  closer  attention  than  any  who  had  preceded  him,  the 
course  of  the  lacteal  vessels,  and  convinced  himself  that  none  of  them 
were  connected  with  the  liver,  but  that  all,  on  the  contrary,  emptied 
themselves  into  the  common  reservoir  of  which  we  have  spoken. 

The  discovery  of  Pecquet  gave  the  last  blow  to  the  ancient  theory 
which  attributed  to  the  liver  the  function  of  hsematosis,  and  it  confirmed 
the  doctrine  of  Harvey  on  the  circulation  of  the  blood,  but,  like  that, 
was  strongly  opposed.  If  we  were  astonished  to  find  at  the  head  of 
its  opponents  the  celebrated  detractor  of  moderns,  John  Piiolan,  we  are 
much  more  astonished  to  see  the  illustrious  W.  Harvey  make,  on  this 
occasion,  common  cause  with  the  Dean  of  the  Faculty  at  Paris. 

From  that  time  the  lymphatic  vessels  and  glands  became  objects  of 
research  by  a  great  number  of  anatomists.  Among  those  whose  labors 
contributed  most  to  develop  the  disposition  and  uses  of  this  order  of 

'^  J.  Pecquet!  Experimenta  nova  anatomica.     Paris,  1654,  iro. 


392  REFORM   PERIOD. 

organs,  we  must  name  John  Vesling,  professor  in  the  University  at 
Padua,  who  discovered  the  thoracic  canal  about  the  same  time  as  Pec- 
quet, the  celebrated  Th.  Bartholin,  Euy.sch,  Olaiis  Rudbeck,  W.  and  J. 
Hunter,  Hewson.  Cruikshank,  and  above  all,  Mascagai,  who  was  the 
first  to  give  a  graphic  description  of  this  whole  apparatus.'"'  A  cer- 
tainty was  now  acquired  that  the  lymphatics,  disseminated  in  infinite 
number  in  all  parts  of  the  body,  in  a  very  variable  and  irregular  form, 
were  arranged  generally  in  two  layers,  the  one  superficial,  the  other  deep- 
seated  ;  that  they  w^re  frequently  interrupted  in  their  course  by  small, 
rounded,  oblong  bodies,  called  conglobate  glands,  or  better,  ganglions, 
and  that  their  functions  consisted  in  carrying  into  the  torrent  of  circu- 
lation, first,  the  chyle,  which  they  draw  from  the  surface  of  the  intes- 
tines ;  secondly,  a  transparent,  colorless,  or  slightly  pink-colored  humor, 
nearly  tasteless  and  inodorous,  called  lymph,  which  they  collect  from  all 
parts  of  the  body. 

NERVOUS     SYSTEM. 

We  have  seen  that  Hippocrates  and  his  successors  in  the  school  of 
Cos,  had  no  precise  notion  of  the  nervous  system ;  they  confounded, 
under  the  term  of  veupa,  nerves,  tendons,  ligaments,  membranes,  and 
true  nerves.  Aristotle  was  but  little  in  advance  of  the  Asclepiadoe  in 
this  matter  ;  he  regarded  the  brain  as  an  inert  mass,  without  sensation, 
and  supposed  that  the  nerves  originated  in  the  heart.  According  to 
him,  they  strengthen  the  articulation  and  aid  the  movements.  Spren- 
gel  attributes  then,  wrongfully,  a  knowledge  of  these  organs  to  the 
philosopher  of  Stagyrus,f  but  more  correctly,  further  on,  gives  the  honor 
of  the  same  discovery  to  Herophilus.J 

It  appears,  in  fact,  according  to  the  most  certain  traditions,  that  the 
physician  of  Chalcedonia  was  the  first  to  unravel  a  little,  the  functions 
of  the  nervous  system.  Piufus,  the  Ephesian,  who  lived  under  Trajan, 
says  that  Herophilus  distinguished  three  sorts  of  nerves:  the  first, 
which  serve  for  sensations  and  voluntary  movements,  proceed  from  the 
brain  and  spinal  marrow,  as  ramuscles ;  the  second  and  the  third  are 
destined  to  unite  the  bones,  and  the  muscles  to  the  bones.  We  see,  by 
this  passage,  that  Herophilus  had  not  yet  entirely  shaken  ofi"  the  pre- 
judice which  confounded  tendons,  ligaments,  and  membranes  with  the 
nerves. 


*  Vasorum  lymphaticorum  Corporis  Humani  Historia  et  Icomographia,  Senis, 
1787,  4vo. 

t  Ihiil,  t.  I,  p.  384.  X  Ibid.  t.  II,  p.  435. 


ANATOMY   AND    PHYSIOLOGY.  393 

Galen  himself  was  not  exempt  from  this  error,  as  any  one  may  be 
convinced  by  the  following  glance  of  the  description  which  he  gives  of 
the  nervous  system.  After  having  spoken  of  the  two  membranes  that 
envelop  the  encephalon,  which  we  know  as  the  dura-mater  and  the  arach- 
noid, he  points  out  the  great  division  of  the  encephalic  mass  into  cerebrum 
and  cerebellum ;  he  describes  each  of  these  parts,  their  respective  posi- 
tion, volume,  consistency,  the  two  substances  that  enter  into  their  com- 
position— the  one  white,  the  other  gray — the  depressions  and  convolu- 
tions on  their  surfaces,  the  ventricles,  etc.  He  regards  the  cerebrum  as 
the  seat  of  the  rational  soul  and  the  origin  of  the  sensitive  nerves,  while 
the  cerebellum,  as  well  as  the  spinal  m.arrow  which  proceeds  from  it, 
give  rise,  according  to  him,  to  the  nerves  of  motion,  which  he  thought 
had  more  consistency  than  the  others.  To  prove  that  the  nerves  are 
the  primary  agents  of  sensibility  and  mobility,  Galen  cites  the  following 
experiment:  "If  we  cut  a  nervous  cord,  or  place  a  ligature  around  it, 
immediately  the  parts  situated  below  the  section  or  ligature  lose  the 
faculty  of  feeling  and  motion."  The  alternate  movements  of  expansion 
and  contraction  of  the  encephalon,  did  not  escape  him,  and  he  regarded 
them  as  a  species  of  respiration  of  the  brain.  He  gives  to  the  great 
sympathetic  nerve  the  name  of  intercostal,  and  says  it  is  derived  from 
the  vagus  nerves,  which  form  the  sixth  pair  in  his  classification.  He 
observed  the  ganglions  that  are  met  with  on  their  track,  but  he  never 
suspected  their  use.  Does  it  not  seem,  from  this,  that  Galen  distin- 
guished perfectly  the  nerves  from  the  tendons  and  the  ligaments  ?  Never- 
theless, he  says,  in  another  place,  that  the  extremities  of  nervous  ramifi- 
cations are  spread  out  into  membranes,  ligaments,  and  tendons.  He 
places  the  sense  of  touch  in  the  membranes  which  envelop  the  muscles, 
and  to  which  he  gave  the  name  of  aponuroses,  on  account  of  their 
supposed  nervous  origin. 

The  anatomists  of  the  sixteenth  century  described  with  more  exact- 
ness than  Galen  the  various  branches  of  the  nervous  system.  They  dis- 
tinguished better  each  part,  followed  farther  the  distribution  of  vessels 
and  nerves,  and  corrected  some  material  errors  of  antit^uity  on  this 
branch  of  anatomy.  They  assured  themselves,  for  example,  that  the 
nerves  of  the  cerebrum,  cerebellum,  and  spinal  marrow,  served  equally 
for  sensation  and  motion.  Nevertheless,  the  most  of  the  ancient  preju- 
dices concerning  the  organs  of  sensibility  and  mobility,  as  well  as  the 
manner  in  which  they  executed  their  functions,  still  existed.  A  suffi- 
cient number  of  experiments  had  not  yet  been  made,  to  establish  a  rational 
opinion  on  this  subject,  consequently  only  more  or  less  plausible  con- 
jectures could  be  formed.  There  was  so  much  uncertainty  on  this  sub- 
ject, that  a  Cesalpinus  could,  without  a  too  great  paradox,  renew  the 
25 


394  REFORM   PERIOD. 

theory  of  Aristotle  which  made  the  heart  the  origin  of  sensation  and  the 
seat  of  the  soul.  Very  much  later,  toward  the  end  of  the  seventeenth 
century,  Baglivi  published  a  theory  which  referred  the  vital  movements 
to  two  structures — the  heart  and  the  dura  mater.  He  supposed  that 
the  latter  is  agitated  by  a  continual  oscillation,  which  is  transmitted 
from  the  membranous  envelope  of  the  nerves  and  thence  to  all  parts.* 

There  remained,  therefore,  at  the  commencement  of  the  Keform  Period, 
an  ample  harvest  of  discoveries  to  be  made  on  the  texture  and  functions  of 
the  nervous  system  in  general,  as  well  as  in  each  of  its  divisions,  in  par- 
ticular. The  progress  of  comparative  anatomy,  and  experiments  on  living 
animals,  during  this  period,  cast  vast  light  on  neurology.  At  the  close 
of  the  last  century,  the  vascular  organization  of  the  gi'ay  substance  of 
the  brain  was  known ;  it  was  no  longer  a  question,  that  the  encephalon 
was  the  organ  of  sensation  and  voluntary  motion,  and  the  seat  of  the 
mind.  The  splendid  researches  of  E.  Vieussens,  Haller,  J.  I'.  Meckel, 
Yicq  d'  Azyr,  A.  Scarpa,  Th.  Soemmerring,  and  of  a  great  number  of 
other  physiologists,  had  put  this  fact  beyond  question.  They  had  de- 
monstrated that  the  dura-mater  receives  no  nerves,  and  that  it  is  desti- 
tute of  all  sensibility  and  could  not  be  the  source  of  any  movement.  It 
was  shown,  also,  by  rigorous  observations,  that  all  the  nerves  coincide 
and  are  united  at  the  base  of  the  brain,  in  that  part  termed  the  protube- 
rance annulare,  from  which  it  was  inferred  with  some  probability,  that 
this  was  the  sensitive  center  of  the  animal — the  place  where  all  the  sen- 
sations centered,  and  from  which  go  forth  all  voluntary  and  reflex  actions. 
Nevertheless,  other  obsei'vations,  of  which  we  shall  speak  farther  on,  led 
to  the  belief  that  the  encephalon  is  a  complex  oi-gan,  each  division  of 
which  fulfils  a  special  function.  At  this  time  Xavier  Bichat  proposed 
to  divide  the  nervous  system  into  two  very  distinct  departments,  though 
united  by  numerous  communications.  One  of  these  departments,  com- 
posed of  the  encephalon,  the  spinal  marrow,  and  their  annexes,  subserv- 
ing, according  to  him,  the  operations  of  the  understanding  and  the  will, 
is  the  principal  organ  of  the  life  of  relation  or  animal  life ;  the  other, 
including  the  great  sympathetic,  its  ganglions  and  plexuses,  gives  im- 
pulse to  the  acts  of  organic  or  individual  life — to  those  functions  in  vir- 
tue of  which  an  individual  transforms  into  his  own  structure  nutritive 
molecules,  and  casts  off  those  which  are  effete,  or  worn  out,  and  injurious 
to  the  system.  This  division,  which  has  been  an  object  of  deep  criti- 
cism, offered  to  its  author  opportunities  to  develop  many  interesting 
observations. 

During  this  period  the  ancient  supposition,  that  the  membranes  were 

^Baglivi,  Opera  Omnia,  Lugduni,  1745,  page  241. 


ANATOMY   AND   PHYSIOLOGY.  395 

entirely  derived  from  nervous  ramifications,  completely  disappeared. 
Very  delicate  dissections  proved  that  the  nerves,  far  from  terminating 
in  aponeuroses,  separate  from  their  neurilema,  and  preserve  only  their 
medullary  pulp  at  their  termination.  Hence  it  was  concluded,  that 
it  is  in  this  last  condition  that  the  nerve  receives  the  immediate 
impression  of  objects,  and  transmits  it  to  the  brain,  by  the  intermedia- 
tion of  the  nervous  filaments.  In  this  way,  exploration  was  made  of 
all  the  functions  of  sensation — sight,  hearing,  smell,  taste,  and  touch. 

How  difierent  is  this  explanation,  so  simple,  based  on  the  anatomical 
disposition  of  parts,  and  separated  from  the  imaginary  hypotheses 
believed  by  the  a.ncients,  and  accepted  by  the  moderns  until  the  begin- 
ning of  the  seventeenth  century!  Empedocles  appears  to  have  been 
the  first  who,  to  render  an  account  of  the  sensitive  impressions,  supposed 
an  elementary  affinity  between  exterior  objects  and  the  organs  of  sense. 
He  thought  that  there  exists  in  each  of  our  organs  a  force  which  governs 
and  attracts  from  other  bodies  the  molecules  similar  to  its  own.  The 
eye,  for  example,  being  of  a  resplendent  nature,  attracts,  he  said,  the 
luminous  molecules  from  bodies ;  the  ear,  which  is  of  an  airy  nature, 
must  attract  sonorous  particles.  The  nose  has  a  vaporous,  the  tongue  a 
humid,  and  the  organ  of  touch,  an  earthy  constitution.  Aristotle, 
Galen,  and  their  successors,  did  not  make  any  special  modifications  in 
this  theory.  They  added  only  to  the  hypothesis  of  Empedocles  the 
consideration  of  spirits,  of  which  they  made  as  many  species  as  we- 
have  difierent  senses.  These  spirits,  invisible  and  impalpable,  were 
secreted  by  the  brain,  and  transmitted  to  the  external  organs  of  sense 
by  the  nerves.  The  visual  spirits  connected  themselves  with  the  organ 
of  sight,  where  they  put  themselves  in  communication  with  the  luminous 
particles  of  bodies  ;  the  auditive  spirits  were  connected  with  the  ear, 
where  they  were  associated  into  sonorous  particles,  and  so  on  for  the 
other  senses. 

From  the  beginning  of  the  seventeenth  century,  the  celebrated  mathe- 
matician Kepler,  announced  that  the  crystalline  lens  is  not,  as  had 
been  supposed  till  that  time,  the  seat  of  vision,  but  that  its  function 
is  to  refract  the  rays  of  light.  He  observed  that  the  image  of  objects 
is  painted  on  the  retina.  The  Jesuit  Scheiner  confirmed  these  observa- 
tions, and  extended  them,  and  demonstrated  that  the  expansion  of  the 
optic  nerve  is  the  essential  part  in  the  organ  of  sight.  Many  other 
learned  men,  and  especially  physicians,  submitted  the  various  membranes 
and  humors  of  the  eye  to  an  attentive  examination,  so  that  this  organ, 
30  marvellous  and  complicated  in  structure,  is  one  of  the  best  understood 
in  the  organism.  The  researches  of  the  great  Newton,  on  light  and 
colors,  Contributed  also  to  perfect  the  theory  of  the  visual  function. 


396  REFORM  PERIOD. 

At  the  same  time,  Casserius  and  other  anatomists  studied  the  organ 
of  hearing.  The  osselets  and  the  small  muscles  of  the  internal  ear,  and 
the  semi-circular  canals,  were  described.  The  acoustic  nerve  was  fol- 
lowed in  its  windings  and  ramifications.  Duverney  published  a  remark- 
able monograph,  in  which,  by  the  aid  of  comparative  anatomy,  he 
corrects  several  errors  which  had  escaped  his  predecessors,  and  adds  new 
details  to  what  was  already  known.  E.  Vieussens  established  the  true 
seat  of  audition  in  the  membrane  which  lines  the  drum  and  labyrinth. 
Lastly,  Cassebohm,  Valsalva,  Morgagni,  Geoffroy,  Lecat,  Comparetti, 
Scarpa,  and  others,  added  several  improvements  to  the  notions  of  their 
predecessors,  on  the  organs  of  sense." 

]\Iany  conjectures  have  been  emitted,  and  many  researches  and  experi- 
ments attempted  by  moderns  to  explain  the  functions  of  the  nervous 
system.  Some  have  regarded  the  nerves  as  tubes  of  extreme  delicacy, 
containing  a  subtle  fluid,  which  receives  the  impression  of  objects  and 
transmits  them  to  a  central  point,  situated  in  some  portion  of  the  brain. 
Others  represent  the  nervous  fibrillar  as  cords,  all  ending  at  a  common 
center.  Charles  Bonnet  renewed  the  hypothesis  of  Hartley,  according 
to  which  each  nerve  is  supposed  to  contain  as  many  distinct  fibers  as  it 
receives  varied  sensations.  For  example,  the  organ  of  sight  must  be 
composed,  according  to  the  naturalist  of  Geneva,  of  as  many  kinds  of  nerv- 
ous filaments  as  there  are  colors ;  that  the  organ  of  taste  must  have  as 
many  varieties  as  there  are  dififerent  flavors ;  and  so  for  the  rest. 

Thomas  Willis  was  one  of  the  first  to  consider  the  brain  as  an  assem- 
blage of  various  apparatuses,  and  assigned  special  functions  to  some  of  its 
divisions.  He  placed  the  seat  of  common  sensation  in  the  corpora  striata 
— the  imagination  in  the  corpus  callosum — the  memory  in  the  cortical 
substance,  etc.  Cabanis,  to  explain  the  influence  of  the  physical  on  the 
moral  man,  compared  the  functions  of  the  encephalon  to  those  of  some 
other  viscera.  He  said  that  the  brain  effects  all  the  operations  of  the 
understanding,  as  the  stomach  and  intestines  accomplish  the  digestion  of 
food — as  the  liver  secretes  bile,  the  kidneys  urine, '•■■'  etc.:  but  is  not  this  an 
abuse  of  induction  ?  and  can  one  establish  a  perfect  similitude  between 
a  material  effort  exercised  on  visible  and  palpable  substances,  as  the 
alimentary  bolus,  which  we  may  follow  in  its  successive  transformations, 
and  the  elaboration  of  thought — the  abstract  and  immaterial  result 
of  a  function  whose  mechanism  is  unrevealed  by  our  senses  ? 

'•'  Besides  these  several  authors,  great  interest  -will  be  excited  by  consulting  the 
fine  researches  made  in  our  times  by  G.  Breschet,  on  the  organ  of  hearing  and 
:auditioninman,  and  the  mamifers,  birds  and  fishes. 

f  Rapports  du  Physique  et  du  Morale,  de  I'Homme,  par  M.  L.  Pcisse. 


ANATOMY   AND   PHYSIOLOGY.  397 

Thus  far  we  have   given  only  hypotheses ;    the   following   opinions 

II  appear  less  conjectural,  and  are  the  result  of  more  attentive  observations : 

;  P.  Camper,  having  compared   a  great  number  of  heads  of  men  and  ani- 

\  mals,  remarked  that,  in  proportion  as  we  descend  from  the  higher  classes 

i  to  those  that  are  inferior  in  the  animal  scale,  the  forehead  recedes  more 

and  more,  and  the  jaws  become  more  elongated.  So  he  thought  that 
the  facial  angle  is  the  most  certain  index  of  the  development  of  the 
intellectual  faculties.  Was  it  from  a  similar  observation  that  the  Greek 
artists  gave  to  the  heads  of  their  divinities  an  elevated  and  prominent 
forehead '?  =•••= 

Pinel  and  other  pathologists  had  already  observed  that  in  various 
states  of  mania,  delirium,  or  partial  insanity,  certain  mental  faculties, 
such  as  the  memory,  attention,  judgment,  imagination,  will,  etc.,  were 
abolished  or  suspended,  while  others  preserved  their  free  exercise,  or 
even  acquired  more  energy  ;  and  they  inferred  from  this,  that  each  of 
the  faculties  must  have,  in  the  brain,  its  own  seat,  or,  in  other  words 
belong  to  a  special  section  of  that  organ. 

After  a  series  of  patient  and  ingenious  observations,  Grail  thought  he 
might  emit  the  following  propositions :  First,  the  development  of  the 
mental  faculties  is  in  constant  proportion  to  the  volume  of  the  brain, 
other  things  being  equal ;  second,  each  part  of  this  viscus  is  the  instru- 
ment of  a  distinct  and  independent  faculty ;  third,  the  cranium  being 
molded  in  nearly  an  exact  manner  upon  the  encephalic  mass,  it  can  be 
determined,  by  the  inspection  of  the  bony  box,  what  is  the  volume  of 
certain  portions  of  the  encephalon,  and  from  this  determine  what  facul- 
ties are  predominant,  or  are  defective,  in  an  individual  submitted  to  an 
examination.  At  the  same  time.  Gall  introduced  an  entirely  new  classifi- 
cation of  the  faculties  of  the  understanding  ;  but  though  he  commenced 
publishing  his  discoveries  before  the  close  of  the  eighteenth  century, 
their  complete  manifestation  and  propagation  belong  to  the  nineteenth  cen- 
tury, and  for  this  reason  we  shall  carry  no  farther  our  exposition  of  his 
system,  f 

ON     GENEEATION. 

The  generative  functions  in  viviparous  animals,  such  as  man,  may  be 
divided  into  three  periods,  namely,  impregnation,  pregnancy,  and 
accouchement.  We  shall  speak  here  only  of  the  first,  the  other  two 
being  referred  to  the  chapter  on  obstetrics.  This  subject  always  occu- 
pied the  reflections  of  philosophers  and  physicians,  who,  in  default  of 
positive  data,  did  not  fail  to  erect  hypotheses,  more  or  less  ingenious. 

"  See  the  work  of  Camper,  published  at  Utrecht  in  1791-92. 

t  Anatomic  et  Physiologic  du  System  Nerveux;  Paris,  1810-1819. 


398  REFORM    PERIOD. 

Galen  describes  with  sufficient  exactness  the  genital  parts  of  man. 
He  very  justly  observed  that  the  artery  and  spermatic  vein  of  the  right 
side  took  their  origin,  one  from  the  aorta,  and  the  other  from  the  vena 
cava,  while  the  artery  and  spermatic  vein  of  the  left  side  emanated  from 
the  renal  artery  and  vein.  The  same  disposition  is  met  with  in  women, 
in  regard  to  the  ovarian  arteries  and  veins.  Moreover,  this  anatomist 
believed  that  there  existed  a  perfect  analogy  between  the  genital  organs 
of  the  two  sexes,  with  this  sole  difference,  that  in  the  male  these  organs 
have  been  pushed  outward  by  the  heat  of  his  temperament,  while  in  the 
female  they  are  retained  within  the  body,  owing  to  her  natural  coldness- 
He  called  the  ovaries  the  testicles  of  the  female,  and  supposed  that  in  copu- 
lation they  secreted  a  spermatic  liquor  analogous  to  that  in  man.  He 
believed,  also,  that  the  womb  was  divided  into  two  cavities,  which  proves 
that  he  had  only  examined  that  viscus  in  the  females  of  animals. 

On  these  anatomical  data,  partially  true,  he  founded  the  following 
explanation  of  the  act  of  generation:  "The  womb,"  he  said,  "having 
received,  at  the  time  of  coition,  the  seminal  fluid  of  the  man  and  of  the 
woman,  the  two  are  mingled.  But  that  of  the  woman  only  serves  to 
nourish  the  other,  and  to  produce  one  of  the  envelopes  of  the  fetus. 
The  semen  of  the  male,  almost  as  soon  as  it  is  received  into  the  womb, 
is  changed  into  membranes.  Some  of  these  membranous  textures 
remain  always  in  the  same  condition,  otliers  become  gradually  thickened 
and  hardened,  and  are  transformed  into  cartilages,  these  into  bones, 
which  serve  as  the  framework  of  the  body.  Others  are  folded  or  hol- 
lowed, and  elongated  in  a  way  to  form  the  tubes  which  are  called  arte- 
ries or  veins.  Others,  in  fine,  are  extended  into  filaments,  and  produce 
fibers  or  nerves.  The  body  of  the  animal  being  thus  arranged,  each 
part  afterward  attracts  that  which  is  necessary  to  it." 

In  relation  to  the  procreation  of  the  sexes,  Galen  shared  the  opinion 
of  Hippocrates,  who  taught  that  the  right  testicle  in  man  furnishes  the 
seed  for  males,  the  left  for  females  ;  that  the  male  embryo  was  always 
developed  in  the  right  cavity  of  the  uterus,  while  the  female  occupied 
the  left. 

Such  is  a  summary  of  the  knowledge  that  antiquity  transmitted  to 
the  middle  ages,  on  the  reproductive  function,  and  which  came  down, 
without  any  modification,  to  the  sixteenth  century.  Then  only  were 
efforts  made  to  rectify  some  of  the  material  errors  of  Galen,  on  the  con- 
formation of  the  genital  organs  of  women.  It  was  demonstrated,  for 
example,  that  the  womb  had  but  one  cavity.  Fabricius  d'Aquapendente 
made  the  first  experiments,  in  order  to  ascertain  the  particular  part 
that  each  portion  of  the  sexual  organ  played  in  the  act  of  reproduction. 
He  killed  pullets  after  coition,  and  saw  that  among  the  little  yellow 


ANATOMY   AND   PHYSIOLOGY.  399 

round  grains,  disposed  like  a  bunch  of  grapes,  which  constituted  the 
ovaries,  that  there  was  one  which  enlarged,  in  which  vessels  were  devel- 
oped, and  which  at  length  became  detached  and  traversed  the  oviduct,  or 
the  cloaca,  to  be  thrown  off  in  the  form  of  an  egg. 

At  a  later  period,  Harvey  repeated  the  same  researches,  on  bitches, 
and  obtained  analogous  results.  He  states  positively,  that  the  matter 
furnished  by  the  female,  in  the  generative  function,  is  a  germ.  He 
emits  the  premature  and  too  general  opinion,  that  every  animal  pro- 
ceeds from  an  egg.  DeGraaf  expsrimentsd  on  rabbits,  and  made  still 
more  precise  observations.  In  explaining  the  texture  of  the  genital 
organs  of  women,  he  substituted  the  word  ovaries  for  the  inconvenient 
term  of  female  testicles. 

In  order  to  ascertain  if  what  Hippocrates  and  Galen  had  said,  was 
true,  touching  the  function  of  the  right  testicle,  which  they  said  always 
generates  males,  and  the  left  one  females,  he  made  the  following  experi- 
ments :  first,  he  took  away  the  right  testicle  of  a  rabbit,  and  afterward 
coupled  it  with  a  female  ;  she  brought  forth,  in  due  time,  young  of  both 
sexes.  Then  he  took  away  the  left  testicle  of  another  rabbit,  with  the 
same  results.  In  order  to  find  out,  also,  if  each  ovary  furnished  ovules 
of  both  sexes,  or  of  one  only,  he  ligated,  in  one  female  rabbit,  the  right 
ovarian  duct,  and  in  another  one  the  left.  Each  one  bore  young  of  both 
sexes :  whence  it  is  permitted  to  conclude  that  the  theory  of  Hippocra- 
tes on  this  subject,  which  had  been  confirmed  by  Galen,  and  adopted  by 
all  antiquity,  must  be  classed  among  fictions. 

A  mass  of  hypotheses  were  conceived,  to  explain  the  mysterious  acts 
of  generation,  but  it  is  not  our  purpose  to  mention  them  here.  AVe 
shall  simply  say  that  they  may  be  reduced  to  two  great  classes,  namely, 
epigenesis  and  evolution. 

In  the  first,  it  is  assumed  that  the  new  being  is  formed,  in  all  its 
parts,  by  the  aggregation  of  molecules  possessing  reciprocal  affinity, 
and  which  arrange  themselves  in  a  certain  order,  nearly  as  occurs  in  the 
phenomenon  of  crystilization.  A  special  force,  to  which  were  given  in 
turn  the  names  of  nature,  pneuma,  soul,  archeus,  plastic  force,  essential 
force,  formative  force,  etc.,  presides  over  the  union  and  co-ordination  of 
these  particles,  and  impresses  on  the  new  being  its  form,  character,  and 
properties. 

The  second  class  admits  that  the  embryo  pre-existed  under  some  form, 
and  being  vivified  by  the  act  of  fecundation,  it  then  commences  a  scries 
of  developments,  which  must  lead  to  the  construction  of  an  individual 
similar  to  the  one  whence  it  proceeded.  The  partisans  of  this  system 
were  divided  into  two  sects — the  ovarists  and  the  animalculists. 

The  ovarists  contended  that  the  matter  furnished  by  the  female  is  an 


400  REFORM   PERIOD. 

egg,  containing  the  germ  of  the  new  being,  and  besides,  a  substance 
which  serves  for  the  nutrition  and  earliest  development  of  the  embryo. 
This  system  was  founded  on  the  observation  of  oviparous  animals. 
In  these,  indeed,  the  female  furnishes,  evidently,  an  egg,  which  even 
in  a  large  number  of  cases,  is  laid,  before  the  connection  of  the  sexes, 
and  is  fecundated  externally. 

The  animalculists  contend  that  the  new  individual  proceeds  from  an 
animalcule  contained  in  the  sperm  of  the  male.  Leeuwenhoek  was  the 
first  who,  by  the  aid  of  the  microscope,  remarked  in  the  semen  of 
animals  a  prodigious  quantity  of  small  bodies,  executing  spontaneous 
movements.  Later  observations  have  proved  that  these  animals,  termed 
spermatazoa,  always  exist  in  recently  ejaculated  sperm,  and  that  similar 
ones  are  not  found  in  any  other  humor  of  the  body — that  they  are 
different  in  different  species  of  animals,  but  are  not  identical  in  the 
same  species.  They  are  not  seen  in  the  sperm  of  an  animal,  except  at  an 
age  capable  of  reproduction,  and  are  absent  before,  as  well  as  after,  that 
period.  Their  number  is  so  prodigious  that  fifty  thousand  have  been 
estimated  in  a  single  drop  of  the  sperm  of  a  cock,  the  volume  of  which 
is  scarcely  equal  to  that  of  a  grain  of  sand.  If  in  any  way,  as  by 
electricity,  distillation,  etc.,  these  animalcules  are  destroyed,  or  if  they 
be  withdrawn  from  the  sperm,  that  liquor  loses  immediately  its  prolific 
virtues.  Such  are,  in  resume,  the  facts  on  which  the  animalculists 
support  their  system.  The  great  Buffon  adopted  this  system,  after 
modifying  it,  and  popularized  it  by  the  charms  of  his  eloquence.  For 
ourselves,  to  explain  in  two  words  our  sentiments  on  the  subject  of  the 
various  systems  of  generation,  imagined  up  to  this  time,  we  say,  in  the 
language  of  Horace:  The  philosophers  have  disputed  on  this  subject 
from  the  beginning  of  the  world,  and  the  question  is  still  undecided, 
Grammatiei  certant,  et  adhuc  subjudice  lis  est. 

ON   VITAL    OR   ORGANIC    PROPERTIES. 

We  have  seen  that  the  ancients  admitted  that  there  are  in  crude 
matter  two  kinds  of  properties — one,  which  they  termed  elementary, 
agrees  with  our  chemical  properties,  and  was  supposed  to  proceed  from 
the  elements  which  entered  into  the  composition  of  all  material  sub- 
stances. These  elements,  as  is  known,  were  four  in  number — fire,  air, 
earth,  and  water.  The  qualities  which  bodies  assumed,  from  their 
relative  proportions,  amounted  to  eight :  thus,  a  body  could  be  simply 
hot,  cold,  dry,  or  moist ;  or  hot  and  dry,  hot  and  moist,  cold  and  dry, 
or  cold  and  moist. 

The  second  order  of  properties,  recognized  by  the  ancients,  compre- 
hended hardness,  elasticity,  porosity,  etc. — in  a  word,  what  we  term 


ANATOMY   AND   PHYSIOLOGY.  401 

physical  properties.  These  were  supposed  to  depend  on  the  figure,  the 
number,  and  arrangement,  of  the  atoms,  or  unalterable  particles  ■which 
constitute  bodies.  I3y  means  of  these  two  orders  of  properties  the 
ancients  flattered  themselves  to  be  able  to  explain  all  the  phenomena  of 
inanimate  nature. 

But  in  regard  to  living  beings — man,  for  example — it  was  impossible 
to  see,  in  the  exercise  of  his  functions,  such  as  generation,  nutrition, 
locomotion,  intelligence,  etc.,  anything  but  the  simple  play  of  elementary 
and  physical  qualities.  Moreover,  the  greatest  philosophers  and  physio- 
logists in  all  time,  agreed  to  regard  each  individual  of  this  class  as 
endowed  with  an  intrinsic,  primitive  force,  named  by  diff'erent  writers, 
essence,  nature,  soul,  spirit,  pneuma,  etc.,  which  superintended,  with 
admirable  instinct,  the  regular  accomplishment  of  all  the  functions, 
unless  interfered  with  by  some  material  obstacle. 

Among  physicians  some  were  especially  attentive  to  the  efiects  of  this 
intrinsic  force ;  they  studied  carefully  its  tendencies  and  followed  most 
scrupulously  all  its  indications :  they  were  called  Hippocratists.  Others 
had  regard,  principally,  to  the  elementary  qualities  of  the  humors ;  these 
were  the  Humoralists,  of  whom  Galen  was  the  highest  representative. 
Others,  in  fine,  who  regarded  chiefly  the  physical  properties  of  the 
solids,  and  in  particular,  porosity,  attributing  to  the  tisssues  only  the 
qualities  of  expansion  and  contraction.  These  were  named  Methodists. 
As  to  the  Empirics,  they  disdained  physiological  considerations,  in  which 
they  were  wrong :  in  a  science  as  complicated  and  as  difficult  as  that 
of  pathology,  we  must  borrow  light  from  all  the  other  sciences.  But 
they  would  have  been  right,  if  they  had  said  to  the  other  sects:  you  are 
not  ignorant  that  the  phenomena  of  the  animal  economy  are  produced 
by  three  orders  of  forces ;  nevertheless,  each  of  you  considers  only  one 
of  those  orders  and  regards  the  rest  as  of  little  or  no  value :  each  one 
of  you  is  therefore  in  error.  Take  for  example  any  function,  say  the 
secretion  of  saliva.  Is  it  not  evident  that  in  this  function,  the  vital 
forces,  the  physical  forces  and  the  forces  or  properties  elementary, 
namely  the  chemical,  concur  simultaneously?  Now  who  can  tell  the 
part  played  by  each  of  these  three  orders  of  forces  in  the  act  of  salivary 
secretion  ?  No  one.  It  is  therefore  impossible  to  form  an  exact  idea 
of  this  function,  as  long  as  an  eff"ort  is  made  to  separate,  by  a  mental 
analysis,  the  forces  which  concur  to  produce  it.  The  function  itself 
must  be  studied,  as  it  is  presented  to  our  observation,  that  is  to  say, 
synthetically  and  experimentally. 

At  the  restoration  of  the  sciences  the  ancient  physiological  systems  were 
reproduced  under  difi'erent  forms :  the  iatro-mathematieians,  versed  in 
the  calculations  of  the  physical  forces,  assumed  to  explain  the  functions 


402  BEFORM   PERIOD. 

of  the  animal  economy  by  the  laws  of  mechanics.  They  could  see  in 
the  secretions,  the  circulation,  and  the  nutrition,  nothing  but  the  effect 
of  the  elasticity  of  tissues,  of  the  calibre  of  vessels,  of  the  friction  of 
liquids,  etc.  The  chemical  physicians  took  into  consideration,  exclu- 
sively, the  mixture  of  chemical  elements ;  they  spoke  only  of  alkaline 
or  acid  humors,  gases,  salts  and  fermentations.  The  Hippocratists 
had  especial  regard  to  the  influence  of  the  intrinsic  force  of  living 
bodies,  a  force  which  they  named  archeus,  soul,  or  vital  principle. 
Up  to  this  time  as  is  seen,  the  physiologists  made  no  distinction  between 
the  properties  of  organic  and  inorganic  matter ;  to  explain  certain 
acts  of  the  animal  economy  they  had  recourse  to  the  intervention  of  an 
immaterial  or  quasi  immaterial  substance,  as  the  soul,  the  archeus  or 
vital  spirits  ;  they  knew  nothing  of  vital  forces  properly  called. 

About  the  middle  of  the  seventeenth  century  Francis  Glisson,  pro- 
fessor in  the  University  of  Oxford,  recognized  in  the  living  solid  tissues 
a  particular  force  which  he  termed  irritahility,  and  which  he  regarded 
as  a  sufficient  cause  for  all  the  phenomena  of  life.  He  said  that  all  the 
tissues  are  endowed  with  this  force  in  different  degrees,  and  proposed 
to  divide  it  into  natural,  vital,  and  animal,  accordingly  as  it  is  mani- 
fested by  movements  more  or  less  apparent,  with  or  without  the  con- 
currence of  the  will. 

These  ideas  made  but  little  impression  on  the  medical  world ;  they 
were  even  forgotten  for  more  than  sixty  years,  when  John  de  Goester,  a 
Dutch  anatomist,  brought  them  again  to  light.  He  however  did  not 
well  distinguish  irritability  from  elasticity ;  the  difference  between 
these  two  forces  had  not  yet  been  established  by  demonstrative  ex- 
periments. Albert  von  Haller  was  the  first  who  directed  his  investiga- 
tions towards  this  end,  and  who,  by  a  series  of  extremely  ingenious 
experiments,  elevated  the  hypothesis  of  Glisson  to  a  demonstrated  fact. 
He  published  in  1747  the  result  of  his  immense  researches,  with  the 
modest  title  of  Primce  Linece  Physiologice,  a  work  in  which  are  traced 
for  the  first  time  the  true  characters  which  distinguish  living  tissues 
from  dead  substances.  The  author  gives,  in  it,  his  opinion  on  the 
vital  contractility  of  tissues,  which  he  distinguishes  perfectly  from 
contractility  or  elasticity.  He  proves  that  the  latter  is  seen  in  all  the 
structures,  in  tendons,  in  membranes,  as  well  as  in  muscles,  and  that  it 
continues  for  a  short  time  after  death  ;  while  vital  contractility  is  only 
found  in  muscles  and  becomes  extinct  with  the  life.  He  thinks  that 
the  latter  proceeds  from  nervous  influence,  for  the  nerves  of  the  spinal 
marrow  being  irritated,  he  says,  the  muscles,  which  receive  their  nerves 
from  these  parts,  are  violently  convulsed,  even  on  dead  animals.  The 
nerve  of  a  muscle  being  tied  or  cut,  it  relaxes,  and  cannot  in  any  way 


ANATOMY   AND   PHYSIOLOGY.  403 

excite  vital  movement;  if  the  ligature  is  taken  off,  it  recovers  its 
vital  contractility.  In  fine,  the  weight  that  a  muscle  can  elevate  during 
life  is  sufficient  to  separate  and  tear  it  after  death." 

Ten  years  later,  in  1757,  Haller  published  the  first  volume  of  his 
great  physiology,  with  the  title  of  Elementa  Physiologice  Corporis 
Humani,  the  whole  of  which  was  not  given  to  the  world  till  1766,  two 
years  before  the  death  of  its  author.  It  was,  if  I  may  be  permitted 
the  poetical  expression,  the  song  of  the  swan,  the  crowning  labor  of  an 
existence  entirely  consecrated  to  the  profit  of  science  and  humanity. 
Haller  proceeded  in  the  entire  work  with  his  usual  circumspection,  advanc- 
ing nothing  but  what  was  supported  on  well  established  facts,  and  giving 
the  least  possible  influence  to  hypothesis.  Eich  in  a  multitude  of  obser- 
vations, which  were  his  own,  and  in  a  vast  erudition,  he  elevated  to  the 
science  of  life  an  imperishable  monument.  From  this  time  physiology 
had  an  existence,  independent  of  physics  or  chemistry.  It  was  demon- 
strated that  life  has  its  laws  and  its  special  forces,  which  must  be 
studied  after  a  particular  method. 

These  new  truths,  which  were  proclaimed  by  Haller,  excited,  in  a 
lively  manner,  the  attention  of  the  learned  world.  On  all  sides,  men 
hastened  to  repeat  his  experiments,  and  to  try  new  ones,  in  order  to 
confirm  or  refute  his  assertions.  The  celebrated  naturalist,  Felix  Fon- 
tana,  was  one  of  the  most  zealous  and  able  advocates  of  the  doctrine  of 
irritability.  Haller,  trying  to  ascertain  to  what  mode  of  structure 
muscular  contractility  was  inherent,  thought  that  this  vital  princi- 
ple depended  upon  gelatine,  combined  with  an  earthy  principle.  He 
remarked,  also,  that  there  are  stimulants  which  act  on  certain  organs, 
but  not  on  others.  Antimony,  for  example,  which  irritates  the  stomach, 
even  in  small  doses,  so  as  to  provoke  vomiting,  does  not  appear  to  have 
any  influence  on  the  heart ;  hence  originated  the  idea  of  specific 
irritability. 

Theophilus  Bordeu  applied  this  idea  to  the  theory  of  secretions.  In 
his  treatise  on  the  position  of  the  glands,  and  their  functions,  he  com- 
bats all  the  chemical  and  mechanical  explanations  with  which  writers 
had  been  satisfied  up  till  that  time,  and  attributes  the  various  sorts  of 
secretions  to  the  proper  action  of  the  glands,  all  of  which,  he  says, 
have  their  specific  tone  and  sensibility.  He  emits  a  conjecture,  which 
was  possibly  the  point  of  departure  for  the  researches  of  Gall,  on  th  e 
philosophy  of  the  brain.  He  says  that  all  the  functions  commence  at 
this  viscus,  which  is  divided  into  as  many  departments  as  there  are 
organs  of  the  body.     The  brain  communicates  its  impulse  to  the  organs 

*  Haller's  Elements  of  Physiology,  French  translation. 


404  REFORM   PERIOD. 

by  the  intermediation  of  the  nerves ;  nevertheless,  he  adds,  this  matter 
is  very  obscure,  and  it  is  necessary  to  multiply  experiments,  to  know 
the  brain,  and  the  uses  of  its  different  parts.'"'^= 

Peter  Anthony  Fabre,  professor  in  the  Faculty  at  Paris,  was  the  first 
one  to  apply  the  doctrine  of  irritability  to  pathology.  He  refuted  the 
mechanical  theory  of  Boerhave,  on  inflammation,  and  proved  that  this 
proceeds,  not  from  the  obstruction  of  the  capillary  vessels,  but  from  the 
exaltation  of  their  irritability.  In  his  microscopical  observations  on 
frogs,  he  perceived  that  the  blood  moves  in  all  directions  in  the  capil- 
lary vessels,  whence  he  concluded  that  in  these  vessels  the  motion  of 
the  fluids  is  no  longer  under  the  impulse  of  the  heart,  but  under  the 
influence  of  irritablity.  f 

Haller  had  demonstrated  the  existence  of  irritability  in  the  muscular 
fiber.  His  disciples  assumed  it  also  for  other  tissues,  as  we  have  just 
seen,  but  it  remained  to  be  proved  by  experiments,  and  a  severe  analysis, 
that  it  does  exist  in  all  the  tissues.  It  was  necessary  to  show  to  what 
degree,  and  under  what  circumstances,  it  manifests  itself  in  each  of 
them ;  in  a  word,  it  was  necessary  to  systematize  the  theory  of  vital 
properties,  to  extend  it  to  all  the  functions :  this  work  was  undertaken 
and  executed  with  much  genius  and  boldness,  by  the  celebrated  Bichat. 

This  man,  whose  career  was  so  short  and  so  complete,  commences  by 
tracing  clearly  the  characters  that  distinguish  vital  fi'om  physical  forces. 
"  The  one,"  he  says,  "varies  unceasingly  in  its  intensity,  energy,  and 
development,  passing  often  with  rapidity  from  the  last  degree  of  pros- 
tration to  the  highest  point  of  exaltation  ;  accumulating  and  wasting,  by 
turns,  in  the  organs,  and  assuming  under  the  influence  of  the  slightest 
causes  a  thousand  various  modifications.  Sleep,  wakefulness,  exercise, 
rest,  digestion,  hunger,  the  passions,  the  action  of  bodies  surrounding 
the  animal,  etc., — all  expose  them  each  moment  to  numerous  changes. 
The  others,  on  the  contrary,  fixed  and  invariable,  are  the  source  of  a 
series  of  always  uniform  phenomena.  Compare  the  vital  faculty  of  feel- 
ing with  the  physical  faculty  of  attraction ;  you  perceive  that  the  attrac- 
tion is  always  in  proportion  to  the  mass  in  which  it  is  observed,  while 
sensibility  changes  constantly  its  intensity  in  the  same  organic  part  and 
in  the  same  mass  of  matter,"  J 

'■'Bordeu,  Recherches  Anatomiques  sur  la  Position  des  Glandes  et  sur  leur 
Action.     Paris,  1751. 

t  Reclierches  sur  diiferents  Points  de  Physiologie,  de  Pathologic  et  de  The'ra- 
peutique.     Paris,  1784. 

J  Bichat,  Recherches  Phjsioligiques,  sur  la  vie  et  sur  la  raort,  pi*e.  partie, 
art.  VII.,  §  1, 


ANATOMY  AND   PHYSIOLOGY,  405 

Bichat  reduced  the  vital  faculties  to  two  species,  namely,  the  faculty 
of  feeling  and  the  faculty  of  contraction ;  but  in  each  of  these  he  admits 
different  degrees ;  thus,  sensibility  is  divided,  according  to  him,  into 
organic  and  animal.  The  first  consists  in  the  faculty  of  receiving  an 
impression ;  it  is  common  to  the  plant  and  to  the  animal ;  the  zoophyte 
possesses  it,  as  well  as  the  quadruped.  The  second  consists  in  the 
faculty  of  receiving  an  impression  and  transmitting  it  to  a  common 
center ;  animals  provided  with  a  nervous  system  are  only  endowed  with 
this.  As  to  contractility,  Bichat  divides  it  also  into  organic  and  animal ; 
accordingly  as  it  is  independent  of  the  brain,  as  in  the  heart,  intestines, 
secretory  organs,  etc.,  or  as  it  is  controlled  by  the  will,  as  in  the  muscles 
of  locomotion,  of  the  voice,  etc. 

In  a  later  work  the  same  physiologist  admits  that  the  vital  properties 
are  susceptible,  not  only  of  exaltation  and  diminution,  but  also  that 
they  may  be  modified  and  rendered  unnatural ;  and  he  bases  on  this  con- 
sideration the  utility  of  specific  remedies.  In  fine,  he  recognizes  a  spe- 
cies of  vitality  in  the  fluids  of  the  animal  economy,  but  he  avows,  at  the 
same  time,  his  inability  to  determine  in  what  this  vitality  consists. 
"  Its  existence,"  he  says,  "  is  no  less  real  on  that  account,  and  the 
chemist  who  analyzes  the  fluids,  has  before  him  only  their  cadaver,  just 
as  the  anatomist  has  but  that  in  the  solids  which  he  dissects."  " 

We  must  not  forget  that  at  this  epoch  numerous  and  beautiful  re- 
searches were  already  made,  by  a  celebrated  surgeon  of  London,  in  order 
to  determine  the  vital  properties  of  one  of  the  most  essential  liquids  in 
the  animal  economy.  The  treatise  of  John  Hunter,  on  the  Blood  and  on 
Inflammation,  had  placed  beyond  question  the  truth  that  the  blood,  while 
it  circulates  in  a  living  body,  enjoys  certain  properties  which  it  loses  when 
it  issues  from  the  vessels,  or  when  the  animal  is  deprived  of  life.  One  of 
the  vital  properties  of  the  blood,  on  which  the  author  insists  the  most,, 
and  which  he  regards  as  the  principle  of  most  of  the  phenomena  of  in- 
flammation, is  the  aptitude  of  that  fluid  to  coagulate  spontaneously, 
that  is  to  say,  without  the  addition  of  any  chemical  agent.  In  fine,  to 
the  authors  whom  I  have  cited  as  having  contributed  to  the  progress  of 
anatomy  and  physiology,  during  this  period,  I  must  add  the  names  of 
Winslow,  Bernard,  Sigefroy,  Albinus,  the  two  Alexander  Monroes,  James 
Douglass,  Vicq  d'Azyr,  and  others. 

"  Anatomie  Gene'rale,  Considerations  Gene'rale. 


406  REFORM  PERIOD. 

CHAPTEK     II. 
HYGIENE. 

This  branch  of  Medicine  was,  during  the  last  historical  period,  con- 
siderably extended.  It  became  the  object  of  meditation,  not  only  of 
physicians,  but  also  of  philosophers  and  learned  men  of  all  classes,  and 
governors  and  statesmen,  who  endeavored  to  ameliorate  the  condition  of 
the  physical  life  of  the  nations,  and  teach  them  more  salutary  habits. 
Considered  from  the  most  elevated  point  of  view,  hygiene  embraces  all 
the  objects  of  nature,  and  all  the  productions  of  art ;  for  there  is  nothing 
in  the  universe  which  may  not  be  beneficial  or  injurious  to  the  health 
of  man.  But  the  limits  of  this  work  and  of  our  knowledge,  force  us  to 
confine  it  to  a  circle  infinitely  more  restrained.  It  is  customary  now-a- 
days  to  divide  hygiene  into  two  great  sections,  accordingly  as  it  refers  to 
man  living  in  society,  or  as  an  isolated  individual.  We  shall  conform 
to  this  arrangement. 


§  I.  On  Public  Hygiene. 

We  have  already  seen  in  the  commencement  of  our  history,  with 
what  foresight  the  legislator  of  the  Hebrews  mingled  with  moral 
precepts  a  great  number  of  hygienic  prescriptions,  appropriate  to  the 
people,  and  the  climate  in  which  they  lived.  The  first  sovereigns  of 
Egypt  had  given  this  example,  before  him.  The  founders  of  the  Greek 
cities  drew  from  that  source  a  part  of  their  religious  rites,  and  their 
hygienic  customs,  to  which  they  added  improvements.  Among  others, 
they  instituted  the  gymnasium,  and  carried  the  gymnastic  art  to  a 
degree  of  perfection  that  has  not  been  since  equaled.  Their  exercises 
had  not  only  the  purpose  of  imparting  strength,  but  also  grace,  supple- 
ness and  agility.  We  know  that  the  athletic  temperament  was  not 
ranked  by  them  among  the  good  temperaments.  In  Sparta,  where  the 
only  object  was  to  make  soldiers,  the  exercises  had  only  the  purpose  of 
hardening  the  body  against  the  fatigues  of  war. 

In  Rome,  gymnastics  took  a  worse  direction  still,  for  it  was  aban- 
doned to  the  gladiators  and  slaves,  who  alone  combattcd  in  the  circuses. 
The  baths  became,  also,  under  the  emperors,  objects  of  luxury  and 
eflFeminacy  rather  than  salubrity.  But  the  construction  of  aqueducts, 
fountains  and  sewers,  the  maintenance  of  cleanliness  in  cities,  the  atten- 
tion to  the  location  of  cemeteries  without  the  limits  of  towns,  and  the 


HYGIENE.  407 

importance  which  was  attached  to  the  duties  of  magistrates,  all  attest 
that  the  earliest  legislators  of  that  sage  people  did  not  neglect  the  care 
of  public  health.  Vitruvius,  architect  to  the  emperor  Augustus,  is 
worthy  of  being  consulted,  not  only  as  regards  the  perfection  of  edifices, 
but  also  in  regard  to  their  salubrity.  He  gives,  next  to  Hippocrates, 
the  best  precepts  on  the  location  of  cities.  He  recommends  that  cellars 
and  public  granaries  be  constructed  on  the  northern  side,  because  a 
southern  exposure  is  unfavorable  to  the  preservation  of  stores.  He  tells 
us  that  the  ancients  consulted  the  livers  of  animals  to  judge  of  the 
nature  of  the  water  of  a  country,  and  the  salubrity  of  its  alimentary  pro- 
ductions ;  so  that  the  inspection  of  the  entrails  of  the  victims  of  the 
priests,  instead  of  appearing  to  our  eyes  as  a  ridicilous  superstition,  was 
really  a  rational  means  to  discover  the  influence  of  the  waters,  airs,  and 
locality,  on  living  beings. 

Among  modern  nations,  the  Turks,  alone,  mix  with  their  religious 
practices  some  hygienic  observances,  such  as  legal  ablutions,  abstinence 
from  certain  aliments,  and  particularly  wine  ;  but  this  last  prohibition, 
which  was  designed  to  protect  the  sectators  of  the  Koran  from  the  vice 
of  drunkenness,  has  created  among  them  a  custom  more  fatal  still — the 
the  use  of  opium.  The  Lent  of  Mussulmen  must  not  be  counted  among 
the  number  of  well  ordered  hj'gienic  institutions,  any  more  than  that  of 
Christians,  for  the  results  seem  to  me  contrary  to  the  true  aim  of 
hygiene.  Doctor  Bruyer  sets  forth,  as  follows,  the  effects  of  the  first, 
upon  health :  "  Knowing,"  he  says,  "  the  repugnance  of  every  Mussul- 
man to  be  out  of  his  house  at  night,  I  made  it  my  pleasure,  as  far  as 
possible,  to  avoid  being  late  in  my  return  at  the  close  of  the  day.  But 
I  was  most  careful  during  Ramazan,  a  month  in  which  all  the  faithful 
take  no  nutriments  from  the  rising  to  the  setting  of  the  sua — not  even 
a  pipe  of  tobacco,  or  a  cup  of  coffee,  or  a  drop  of  water.  This  fast — 
always  painful  to  a  lodger — is  truly  intolerable  for  a  laborer,  especially 
when  its  observance  takes  place,  as  I  have  known  it,  during  the  longest 
days  of  the  year ;  so  to  economize  their  strength,  the  boatmen  row  us 
as  slowly  as  possible.  How  often  have  I  encountered,  at  the  dif- 
ferent quays  of  Constantinople,  those  who,  fresh  and  active  at  the  com- 
mencement of  the  fast,  were,  at  its  close,  so  dried  up,  thin  and  wrinkled 
that,  without  my  dragoman,  I  could  not  have  recognized  them."* 

In  the  Christian  church,  which  proposes  to  elevate  man  to  the  highest 
degree  of  moral  perfection,  and  free  him  from  the  bondage  of  his  pas- 
sions,  we  must  not  search  for  hygienic  rules  embodied  in  ecclesiastic 

*  Neuf  annees  a  Constantinople.  Paris,  1836,  T.  I,  p.  149,  cliap.  I,  sixieme  ex- 
cursion. 


408  REFORM    PERIOD. 

ordinances,  but,  owing  to  the  intimate  union  which  exists  between 
hygiene  and  morals,  it  often  happens  that  the  maxims  of  the  Church  are 
excellent  hygienic  precepts.  As  to  the  European  governments  of  the 
middle  ages,  the  sole  general  measures  of  salubrity  of  which  their  history 
has  transmitted  to  us  the  account,  are  the  regulations  concerning  the 
sequestration  of  the  leprous,  and  the  establishment  of  free  baths  for  the 
poor.  Also,  it  must  be  said  that  the  attention  to  the  cleanliness  of  these 
was  so  badly  observed  that  the  baths,  themselves,  often  became  a  focus 
for  the  propagation  of  contagious  diseases.  AVhen  syphilis  took  the  place 
of  leprosy,  a  part  of  the  ordinances  relative  to  leprosy  were  applied  to 
syphilitics,  as  has  been  heretofore  remarked. 

It  was  but  a  short  time  before  the  beginning  of  the  seventeenth  cen- 
tury that  the  governments  of  Europe  occupied  themselves  with  the  state 
of  public  health.  The  lazaretto  at  Marseilles,  was  the  first  estab- 
lishment founded  to  prevent  the  communication  of  the  plague  from  the 
East.  Wise  and  strict  regulations  were  promulgated  on  that  occasion, 
and  they  have  served  as  a  model  for  all  lazarettos  founded  successively 
in  the  other  ports  of  the  Mediterranean. 

The  idea  of  a  lazaretto  was  first  conceived  by  French  merchants  who 
resided  at  Cairo  and  Alexandria.  These  merchants,  observing  that  the 
Coptic  monks,  isolated  in  their  convents,  seemed  to  be  secure  from  the 
pest,  confined  themselves  also  to  their  houses  in  the  times  of  the  epidemic, 
and  communicated  with  their  neighbors  only  from  the  windows  or  from 
the  tops  of  the  terraces  that  crown  most  of  the  edifices  in  the  Orient. 
The  advantages  which  they  reaped  from  this  custom  were  such,  that  it 
is  maintained  perfectly  as  a  custom  to  this  day.  The  Frank  quarter,  in 
Constantinople,  is  generally  preserved  from  the  plague  by  a  careful 
sequestration,  while  the  Turks,  imbued  with  the  dogma  of  predestination, 
neo-lect  all  prudent  measures,  and  perish,  victims  to  their  blindness. 

At  present,  commerce  earnestly  protests  against  the  rigor,  and  espe- 
cially against  the  duration  of  quarantines.  The  opinion  of  a  majority 
of  physicians  is  favorable  to  a  reform  in  this  respect,  and  there  are  men 
who  go  so  far  as  to  discredit  the  utility  of  these  establishments  and 
demand  their  suppression.  Nevertheless,  if  we  compare  the  small 
ravai"es  that  the  plague  has  made  in  Christian  Europe  since  their  estab- 
lishment, with  the  frequency  of  its  invasion  before  that  epoch,  it  will  be 
difficult  to  deny  the  importance  and  efficacy  of  these  preventive  measures. 
From  1476  to  1649 — that  is  to  say,  in  a  space  of  less  than  two  hundred 
years — the  plague  prevailed  sixteen  times  in  the  city  of  Marseilles. 
Now,  it  was  only  in  the  first  part  of  the  seventeenth  century  that  any 
one  seriously  thought  of  it  as  a  contagion,  and  employed  any  means  to 
prevent  it.     Up  to  that  time  pestilential  epidemics  had  been  generally 


HYGIENE.  409 

regarded  as  a  scourge  from  heaven,  whose  progress  no  human  barrier 
could  arrest,  and  no  more  efforts  were  made  to  preserve  the  people  from 
its  ravages  than  are  made  among  Musselmen.  But  aftpr  1649,  i.  e. 
after  the  establishment  of  lazarettos  and  the  rigorous  observation  of 
sanitary  rules,  the  plague  has  prevailed  but  once  in  Marseilles  during 
the  space  of  nearly  two  hundred  years.-  It  is  possible,  and  very  proba- 
ble, that  in  the  institution  of  quarantines,  the  measure  of  strict  neces- 
sity may  have  been  passed,  but  it  does  not  seem  to  me  logical  from  this 
to  argue  their  inutility.f 

It  would  be  too  long  to  enumerate  all  that  has  been  done  or  under- 
taken within  two  centuries  to  render  cities,  camps,  districts  of  country, 
vessels,  barracks,  workshops,  hospitals,  prisons,  etc.,  more  salubrious.  I 
should  be  compelled  to  refer  to  the  works,  not  only  of  physicians,  but 
also  of  chemists,  philosophers,  magistrates,  generals,  navigators,  etc. ; 
for  public  hygiene  is  connected  with  all  the  sciences  and  arts,  either  to 
profit  by  their  light  or  in  turn  to  benefit  them  by  its  own,  so  as  to  make 
all  converge  to  the  well-being  of  the  people.  The  abundance  of  mate- 
rials, therefore,  becomes  an  obstacle  to  their  just  appreciation.  Ho'vt 
could  we  discern  fi-om  among  so  many  writings,  discoveries,  and  improve- 
ments, those  which  merit  the  preference  ?  It  would  be  impossible  for 
me  to  avoid  omitting  some  works,  worthy  as  much  to  be  mentioned,  and 
possibly  more  so,  than  certain  of  those  of  which  I  should  speak.  How 
shall  I  depict  all  the  efforts  attempted  in  the  last  centuries  by  govern- 
ments, municipal  authorities,  learned  societies  in  particular,  in  order  to 
ameliorate  the  physical  condition  of  man  ?  The  enlarging  and  opening 
of  streets,  the  draining  of  stagnant  waters,  the  removal  of  filth,  the  re- 
location of  cemeteries  and  insalubrious  manufactories  from  the  centers  of 
population,  the  draining  of  marshes,  the  chemical  analysis  of  the  air, 
drinks,  and  alimentary  substances,  so  as  to  determine  of  their  elements 
those  which  are  advantageous  or  injurious  to  health,  the  research  of 
means  proper  to  preserve  food,  and  the  regulations  of  a  sanitary  police, — 
these  are  some  of  the  objects  which  have  occupied  learned  men  and 
statesmen. 

The  Royal  Society  of  Medicine  gave  a  strong  impulse  to  the  labors 
concerning  public  hygiene,  by  the  questions  put  in  the  public  concours 


•^The  plague  of  1720  was  the  last  that  existed  in  that  city,  although  it  has  fre- 
quently been  met  with  at  its  lazaretto,  where  it  was  arrested. 

t  See  the  Dictionnaire  des  Scienc.  Medicales,  art.  Hy«iene,  by  ITalle'  and  Nysten  ; 
art.  Lazaret,  by  Fode're.  See  also  the  remarkable  and  important  report  made  to 
the  Royal  Academy  of  Medicine,  on  the  Plague  and  Quarantine ;  Bulletin  de 
I'Acad^mie  Royale  de  Me'decine,  Paris,  1846,  t.  xi. 

26 


410  REFORM   PERIOD. 

by  the  reports  of  its  committees,  and  by  the  correspondence  it  main- 
tained with  physicians  of  all  countries,  who  furnished  them  their 
observations  on  epidemics,  topography,  and  in  general,  on  everything 
that  concerned  public  health.  John  Howard  ofiFered  to  the  world  the 
first  example,  perhaps,  of  a  man  who  traveled  neither  for  his  own 
pleasure  or  health,  nor  for  any  advantage  or  personal  interest,  but  solely 
for  the  love  of  humanity.  Hospitals,  prisons,  and  lazarettos,  attracted 
his  attention  ;  he  devoted  his  fortune  and  his  existence  to  the  ameliora- 
tion of  the  condition  of  the  unfortunate,  who  were  shut  up  in  them. 
A.  A.  Parmentier  signalized,  also,  his  zeal  for  the  poor,  by  occupying 
himself,  successfully,  in  regard  to  means  to  increase  their  alimentation. 
Thompson,  Count  Eumford,  illustrated  and  made  dear  his  paternal 
administration,  in  Bavaria,  by  the  establishment  he  founded  for  the 
purpose  of  procuring  labor  and  bread  for  necessitous  classes.  Guyton- 
Morveau  proposed  excellent  means  of  disinfection,  which  are  still 
employed  in  many  cases.  The  health  of  soldiers  and  seamen  attracted 
the  attention  of  many  observers,  and  gave  rise  to  numerous  publications, 
among  which  we  distinguish  those  of  Eouppe,  Lind,  Poissonnier  des 
Perrieres,  Pringle,  Donald  Monro,  Van  Swieten,  Colombier,  Gilbert  and 
Desgenettes. 

But  of  all  the  conquests  which  public  hygiene  has  made  in  these 
latter  times,  there  is  one  which  merits  a  special  mention.  Variola  pre- 
vailed, periodically,  in  both  worlds  ;  it  took  from  the  population  of  Eu- 
rope an  annual  tribute  which  is  estimated  to  have  amounted  to  not  less 
than  four  hundred  thousand  souls,  and  mutilated  and  disfigured  nearly 
as  many  more.  A  woman  of  great  spirit  and  character.  Lady  Wortley 
Montague,  had,  indeed,  imported  from  Constantinople  the  practice  of 
inoculation,  which  has  much  merit,  but  is  not  free  from  reproach, 
because  it  exposes  its  subjects  to  almost  as  much  danger  as  the  spon- 
taneous contagion. 

A  physician  of  Barkley,  a  city  of  the  county  of  Gloucester,  having 
heard  it  said,  or  having  remarked,  that  the  disease  known  in  the  western 
provinces  of  England  under  the  name  of  cow-pox,  was  communicated  to 
those  who  kept  or  milked  cows  habitually,  and  that  this  afifection,  which 
was  very  slight,  protected  completely  those  who  had  passed  through  it, 
from  the  variolic  affection,  meditated  on  this  strange  fact,  verified  it, 
and  c6nceived  the  happy  idea  of  inoculating  children,  directly,  with 
the  virus  taken  from  the  udder  of  the  cow.  At  the  end  of  three,  four, 
or  five  days,  he  saw  pustules  developed,  at  all  the  points  of  the  skin 
which  he  had  pricked,  similar  to  those  of  cow-pox  ;  then  the  pustules 
broke,  the  pus  dried  and  formed  a  small  crust,  which  in  falling  left  a 
cicatrice.     Besides,  there  was  little  or  no  fever,  the  children  continuing 


HYGIENE.  411 

to  eat  and  play  as  usual  without  realizing  any  bad  symptoms.     Not  one 
of  those  children  was  ever  attacked  by  variola. 

Jenuer,  after  having  repeated  his  experiments  for  a  number  of  years, 
and  being  assured  of  the  inocuous  character  of  the  virus,  and  its 
prophylactic  virtue,  convinced,  finally,  of  the  reality  and  grandeur  of 
his  discovery,  decided  to  make  it  public,  and  consigned  all  the  details 
of  the  subject  to  a  volume  printed  at  London,  in  the  year  1798."  Great 
was  the  stupefaction  in  the  medical  world  at  the  announcement  of  such 
an  astonishing  marvel.  It  seemed  impossible  to  imagine  that  a  pest  as 
ancient  and  as  formidable  as  variola,  could  be  expelled  forever  by  a  pro- 
cess so  simple  and  benign  as  vaccination.  The  discovery  of  Jenner  met, 
at  first,  with  much  opposition.  The  incredulous  raised  against  it  many 
objections  of  every  kind,  and  it  gave  rise  to  a  very  spirited  polemic 
between  its  defenders  and  opponents ;  but  I  shall  not  retrace  the  phases 
of  this  contest  now  terminated,  and  whose  ultimate  result  has  been  the 
adoption  of  the  new  specific,  in  every  country  into  which  European  civili- 
zation has  penetrated.  I  will  only  observe  that  after  the  victory,  there 
was  a  disposition  to  contest  with  Jenner  the  honors  of  his  triumph  ; 
some  ambiguous  passages  from  old  books  were  uncovered  from  the  dust 
of  libraries,  and  certain  popular  traditions  were  recalled,  that  had  pre- 
vailed in  some  obscure  province,  to  find  in  them  the  germ  of  the  admi- 
rable discovery  of  the  English  physician,  as  if  all  ideas,  all  new  inven- 
tions, are  not  the  consequences  of  some  anterior  idea  or  invention  !  But 
even  this  does  not  diminish  the  glory  of  the  discoverer,  for  the  develop- 
ment given  by  him  to  those  ancient  ideas  is  great  in  itself,  and  emi- 
nently useful  in  its  results.  Xow  when  I  consider  the  sagacity,  patience, 
and  exquisite  judgment  of  which  Jenner  gave  proof  in  his  long  experi- 
ments, when  I  consider  the  immense  benefit  of  his  discovery,  I  no  longer 
discuss  his  genius,  I  have  language  only  to  praise  and  bless  him ! 


§  n.  Private  Hygiene. 
Among  the  original  and  important  writings  with  which  this  department 
of  hygiene  was  enriched  during  this  period,  I  will  cite,  in  the  first  place, 
that  of  Sanctorius,  entitled,  Aphorisms  on  Static  Medicine.  It  was  com- 
posed under  the  following  circumstances :  Being  desirous  to  estimate  the 
quantity  of  insensible  humor  that  was  exhaled  each  day  from  the  human 
body,  and  to  determine  the  relations  which  connect  this  function  with 
the  various  actions  of  the  different  states  of  the  economy,  such  as  diges- 
tion, exercise,  repose,  health,  disease,  age,  season,  etc.,   this  physician 

■^  .Jenner,  An  Inquiry  into  the  Causes  and  Effects  of  the  Variolae  Vaccinas. 
London,  1798. 


41-2  REFORM   PERIOD. 

had  the  idea  of  arranging  a  seat  on  the  platform  of  a  balance,  in  such 
a  way  as  to  be  able  to  take  the  weight  of  the  body  at  every  hour  of  the 
day,  if  he  desired  it,  both  before  and  after  sleep,  meals,  the  emission  of 
urine  and  feces,  in  a  word,  before  and  after  each  function  whose  opera- 
tion is  important  to  life.  He  continued,  for  thirty  years,  his  daily 
experiments;  then  he  consigned  the  general  results  which  he  had 
obtained,  in  a  small  collection  of  aphoristic  sentences,  of  which  the  fol-g 
lowing  are  specimens : 

"  All  diseases  proceed  from  an  excess  or  defect  of  transpiration.  If 
a  physician  who  has  the  care  of  a  man's  health,  has  regard  only  to  the 
nutrition  and  sensible  evacuations,  without  knowing  how  much  trans- 
pires each  day  from  those  who  are  confided  to  him,  he  is  ignorant  of 
their  true  condition,  and  is  unworthy  of  the  title  of  doctor  in  Medicine. "'~' 

"To  evacuate  very  much  by  stools,  urine,  or  sweat,  and  but  little  by 
transpiration,  shows  a  state  of  disease. "f 

"  Why  is  swooning  of  great  utility  in  high  fevers  ?  Because  it  dis- 
poses the  body  to  sweat  freely."| 

"  A  man  in  health  loses  in  a  day,  by  transpiration,  as  much  as  he 
passes  in  fifteen  days  by  the  bowels,  though  he  have  a  stool  of  perfect 
fecal  matter  every  day."§ 

"  If  a  person  drinks  to  excess  during  the  night,  and  the  body  returns, 
neither  by  coction  nor  indigestion,  the  next  day,  to  its  naturalstate,  the 
following  verses  are  applicable  to  his  state : 

Si  Ton  est  malade  au  matin, 
D'avoir  passe  la  nuit  a  hoire, 
II  faut  envoyer  chez  Gre'goire, 
Et  se  guerir  avec  du  vin."|| 

If  3'ou  find  yourself  sick  in  the  morning, 
Having  passed  the  night  in  debauch. 
The  wine  of  Gregory  will  cure  you. 
Send  quickly  to  him  for  a  draught. 

"He  who  sleeps  transpires  double  as  much  as  when  he  is  awake. 
Hence  the  following  axiom :  Two  hours  rest  when  awake,  are  not  worth 
much  more  than  one  hour  of  sleep.  "=•■■" 

The  publication  of  Sanctorius  was  hailed  as  a  revelation  from  the 
god  of  Medicine,  a  true  code  of  hygienic  laws.  Their  author  was 
saluted  with  the  title  of  second  Hippocrates,  and  his  sanatory  maxims 
put  on  a  level,  or  above  those  of  the  old  man  of  Cos.  His  salary  as 
professor  in  the  University  of  Padua,  was  continued  to  him  by  a  decree 

"'  1st  section,  Aphor.  2d,  translation  of  Lebreton.     Paris,  1722. 
1[Ibid.  Aphor.  14.     JAphor.  98.     §Sec.  3d  Aph.lO.   l|Aph.78.     «»4th  sec,  Aph.  18. 


k 


I 


HYGIENE.  413 

of  the  Senate,  and  Venice,  where  he  finished  his  days,  in  1636,  erected 
a  statute  to  his  memory. 

Nevertheless,  if  we  submit  to  a  severe  critic  the  work  of  Sanctorius, 
we  find  it  reprehensible  in  several  respects.  In  the  first  place  his  con- 
clusions are  too  general  and  too  absolute,  for  from  experiments  made 
upon  one  individual  in  one  climate,  he  makes  inductions  for  every  body 
and  for  all  climates.  In  the  second  place,  several  inevitable  causes  of 
error  entered  into  his  calculations,  among  others,  the  two  following :  he 
took  no  account  of  the  pulmonary  exhalation  and  absorption,  nor  of 
cutaneous  absorption.  In  fine,  several  observers  have  repeated  in 
various  countries  the  experiments  of  Sanctorius,  and  all  obtained 
extremely  variable  results.  From  this  it  appears  that  there  is  nothing 
more  changeable  than  cutaneous  transpiration,  and  that  to  determine 
its  quantity  would  be  as  impossible,  says  Bichat,  as  to  pretend  to  specify 
the  volumes  of  water  that  are  vaporised  each  hour,  by  a  heat  whose  in- 
tensity varies  each  moment.  The  only  general  conclusion  which  may 
be  drawn  from  these  numei'ous  experiments  is,  that  in  a  state  of  health 
this  excretion  is  ordinarily  very  abundant — that  it  is  less  when  we  are 
awake,  and  that  in  every  case  it  merits  the  attention  of  the  physician 
as  well  as  the  physiologist.  If  then  these  aphorisms  of  Static  medicine 
do  not  justify  the  enthusiasm  which  their  appearance  excited,  they  do 
no  more  merit  the  neglect  into  which  they  have  fallen  in  our  days. 
H.  Boerhaave,  whose  judgment  has  had  justly  much  weight,  says  that 
no  other  book  in  medicine  has  been  written  with  so  much  care,  and 
Lorry  has  added  to  it  commentaries  worthy  of  being  meditated  upon  in 
all  time  to  come/-'^ 

Cheyney,  a  physician  in  London,  had  very  much  impaired  his  health 
by  excess  of  pleasure  and  good  living.  He  became  excessively  cor- 
pulent, and  sufiered  all  the  inconveniences  of  that  state,  such  as 
dyspepsia,  lethargy,  indolence  and  other  evils.  He  devoted  several 
years  to  the  care  of  his  health,  and  had  the  happiness  to  re-establish 
it  perfectly,  by  means  of  a  country-life,  milk  and  vegetable  diet,  exercise 

''  De  Medicina  Statica,  Aphorismi,  Parisiis,  1770,  12mo.  Sanctorius  has  esti- 
mated the  quantity  of  transpiration,  compared  with  that  of  the  urine  and  feces 
taken  together,  in  the  proportion  of  5  to  3.  Denis  Dodard  a  physician  in  Paris, 
found  that  the  transpiration  is  to  all  other  excretions  as  12  is  to  15.  Sauvages, 
in  the  south  of  France,  and  Gorter  in  Holland,  obtained  results  similar  to  the 
latter.  James  Keill,  who  experimented  in  England,  assumes  that  the  quantity 
of  urine  surpasses  that  of  the  transpiration  at  the  rate  of  38  to  31.  Linning, 
who  observed  this  matter  in  South  Carolina,  says,  that  the  transpiration  exceeds 
the  urine  for  five  months  of  the  year,  and  that  the  opposite  occurs  during  the 
other  seven  months.  We  see  therefore  that  there  are  as  various  results  as  there 
are  observers,  which  makes  the  reflection  of  Bichat  entirely  true. 


414  REFORM   PERIOD. 

and  the  Bath  waters ;  so  that  he  was  enabled  to  resume  his  very  active 
occupation  and  continue  in  it,  to  the  cose  of  his  life  which  took  place 
at  the  age  of  seventy-two.  Cheyney  enjoyed  a  great  reputation  as  a 
practitioner.  He  has  left  several  works,  of  which  the  most  estimable 
is  a  monograph  on  the  art  of  preserving  health  and  prolonging  the  lives 
of  valetudinarians.  He  gives  in  it  precepts  which  are  still  profitably 
read.  He  exalts  above  all,  the  regimen  suited  to  his  condition,  as  did 
Carnaro,  whose  history  we  have  already  given. 

Among  the  other  writings  which  contributed  to  improve  hygiene 
during  the  last  century,  I  will  cite  the  following  monographs  :  that  of 
J.  B.  Fisher,  and  of  M.  J.  Eoberts,  on  Old  Age  and  its  Diseases ;  that 
of  Eamazini,  on  the  Diseases  of  Artisans,  which  Fourcroy  enriched  by 
interesting  notes ;  the  writings  of  Lorry,  Junckcr,  Bebdoes,  J.  Arbuthnot, 
Halle  ;  those  of  Tissot,  which  have  enjoyed  so  much  popularity ;  in 
fine,  the  general  treatises  of  Tourtelle,  Moreau  de  la  Sarthe ;  the 
Treatise  on  Medical  Police,  by  J.  P.  Frank  ;  the  Code  of  Health,  by 
John  Sinclair,  etc.'"' 


CHAPTER   III. 

GENERAL    PATHOLOGY. 

Pathology  was  studied,  during  this  period,  under  various  aspects, 
which  we  shall  here  content  ourselves  with  indicating,  very  summarily ; 
but  will  speak  of  it  much  more  explicitly  in  other  places,  particularly 
in  the  chapters  devoted  to  the  exposition  of  theories  and  systems. 
Some  gave  the  principal  credit  to  humors,  in  the  generation  of  diseases, 
conformably  to  the  modified  Galenic  doctrine,  or  followed  the  pi'inciples 
of  the  new  chemistry  ;  others  saw  in  every  morbid  disorder  only  an 
error  or  trouble  in  the  governing  principle  of  the  economy,  which  they 
named  archeus,  soul,  nature,  or  vital  principle  ;  others  considered  dis- 
eases as  a  mechanical  or  dynamical  derangement  of  the  action  of  the 
solids  ;  others,  in  fine,  banished  from  pathology  the  consideration  of 
the  causes  and  phenomena  which  were  not  manifest  to  the  senses,  and 
insisted  on  the  results  to  be  obtained  from  pure  observations  only. 
From  these  dificrent  modes  of  regarding  diseases,  there  followed  very 
different  pathological  classifications,  and,  in  definitive,  a  more  profound 
and  complete  knowledge  of  the  morbid  state. 

'"'  A  new  edition  of  the  Traite  des  Maladies  des  Artisans,  with  considerable 
additions,  was  published  by  Doctor  Ph.  Patissier.     Paris,  1822,  8vo. 


INTERNAL  PATHOLOGY.  415 

CHAPTEE    IV. 
INTERNAL    PATHOLOGY. 

§  L  Semeiotics. 

A  great  number  of  physicians  devoted  themselves,  during  this  period, 
to  the  study  of  symptoms,  abstractly  considered,  and  endeavored  to 
establish  more  precisely  their  value.  They  were  persuaded  that  each 
symptom  has  its  own  signification,  independent  of  the  concourse  of  other 
accidents,  and  they  strove  to  determine  that  signification.  We  have 
seen  Sanctorius  seeking  the  indications  of  good  and  bad  health,  in  the 
variable  quantity  of  insensible  perspiration  which  exhales  from  our 
bodies  at  diff'erent  hours  of  the  day.  Others  flattered  themselves  to  be 
able  to  find,  in  modifications  of  the  pulse,  signs  more  certain,  concerning 
the  seat  of  diseases,  their  cause,  gravity,  and  probable  issue. 

A  Spaniard,  named  Solano  de  Luque,  was  the  first  who,  devoting 
himself  to  these  researches,  studied  the  pulse.  He  studied  medicine 
at  Cordova,  under  Joseph  de  Pablo.  During  his  studies  he  observed 
the  dicrotic  or  rebounding  pulse,  so  called  when  two  rapid  pulsations  are 
felt,  followed  by  a  short  pause.  Astonished  at  this  phenomenon,  he  asked 
his  master  what  interior  condition  of  the  body  agreed  with  that  sort  of 
pulse,  and  he  received  the  odd  reply,  that  all  these  insignificant  modi- 
fications are  produced  by  the  sooty  vapors  contained  in  the  arteries. 
The  student,  but  little  satisfied  with  such  an  explanation,  redoubled  his 
care  in  researches,  and  came  to  the  conclusion,  that  the  dicrotic  pulse 
is  a  constant  indication  of  epistaxis. 

He  observed,  also,  that  a  modification  no  less  remarkable,  in  the  pulse, 
usually  precedes  a  critical  sweat.  This  modification  is  a  first  pulsation, 
followed  by  three  others,  which  increase  to  the  last,  somewhat  like  the 
billows  of  the  sea  that  roll  upon  the  shore ;  then  commences  another 
series  of  four  pulsations,  of  which  the  first  is  always  the  feeblest,  and 
which  gradually  augment  in  force.  He  named  this  pulse  the  inciduus, 
because  the  fourth  pulsation,  which  is  the  strongest  of  the  series,  is 
succeeded  by  the  first  or  the  feeblest  pulsation  of  the  following  series, 
so  that  the  pulse  seems  to  fall  in  passing  from  one  quartenary  series 
to  another.  Besides,  it  is  ordinarily  compressible,  soft,  and  in  that 
case  it  announces,  as  we  have  remarked,  a  sweat ;  but  if  it  exhibits 
itself  accompanied  with  very  much  hardness,  it  is  the  precursor  of 
jaundice. 

The  intermittent  pulse  is  that  in  which  a  certain  number  of  pulsa- 
tions are  observed,  followed  by  a  longer  interval  than  is  usual.    According 


416  REFORM    PERIOD. 

to  Solano,  this  kind  of  pulse  habitually  announces  a  critical 
diarrhea.  If  it  is  soft,  also,  it  indicates  abundant  urine ;  if,  on  the 
contrary,  it  is  hard,  we  may  expect  vomiting.  These  are  the  only 
species  of  pulse  on  which  Solano  made  his  observations.  He  consigned 
them  to  a  large  folio,  where  they  are,  as  it  were,  drowned  in  the  midst 
of  an  ocean  of  subtilties.  They  produced  no  sensation  in  the  Medical 
world  until  they  were  drawn  from  obscurity  by  an  English  physician, 
James  Kihell,  who  gave  a  summary  of  them,  to  which  were  added  the 
results  of  his  own  experience. 

Sphygmics  acquired  a  very  different  importance  from  the  researches  of 
Theophilus  Bordeu.  This  observer,  whose  sagacity  we  have  already 
appreciated,  undertook  to  connect  all  shades  of  health  and  disease  to 
certain  variations  of  the  pulse.  He  took,  in  the  first  place,  the  pulse  of 
a  good-conditioned  adult,  for  a  type  of  a  natural  and  perfect  pulse,  the 
character  of  which  he  traced  as  follows:  "This  pulse  is  regular,  and 
is  pulsations  are  perfectly  identical,  and  occur  at  equal  intervals.  It 
is  soft,  supple,  free,  neither  fi-equent  nor  slow — vigorous  without  being 
laborious.  "•■^ 

Taking  this  as  a  type,  the  author  points  out  an  incredible  number  of 
species  and  varieties,  which  are  more  or  less  removed  from  each  other. 
He  distinguishes,  for  example,  a  particular  pulse  for  each  organ ;  among 
others,  he  has  a  nasal,  gutteral,  pectoral,  stomachal,  intestinal,  hepatic, 
splenic,  renal,  menstrual  pulse,  etc.  He  allows  a  specific  difference 
between  the  pulse  of  organs  situated  above,  and  those  situated  below  the 
diaphragm,  and  another  between  those  of  the  right  and  left  half  of  the 
body.  Then  he  gives,  also,  the  infinite  varieties  of  the  pulse  produced 
by  the  passions  and  diseases,  as  well  as  by  certain  medicines. 

We  shall  not  attempt  to  follow  this  author  into  the  labyrinth  of 
distinctions,  more  subtile  than  real,  into  which  he  enters.  If  it  were 
true  that  each  physiological,  pathological,  and  even  psychical  act 
is  revealed  by  the  different  shades  in  the  pulse,  what  tact,  sufficiently 
exercised  or  refined,  would  be  able  to  seize  these  shades,  often  as  imper- 
ceptible and  instantaneous  as  those  of  thought  ?  "What  light  could  be 
obtained  from  the  extremely  delicate  and  fugitive  variations  of  the  pulse, 
when  its  most  remarkable  permanent  modifications  have  only  an  equivo- 
cal signification,  and  are  connected  with  very  varied  states  of  the  health  ? 
Thus  the  intermittence  of  pulsation  is  sometimes  a  symptom  of  no 
importance,  while  at  other  times  it  is  one  of  the  most  grave.  Analysis, 
as  a  method  of  research,  has  been  very  much  and  properly  praised  in 
our  times,  but  every  method  has  its  faults,  and  we  shall  have,  on  more 

*  Bordeu,  Recherches  sur  le  pouls  par  rapport  au  crises,  chap.  ni. 


INTERNAL   PATHOLOGY.  417 

than  one  occasion,  to  observe  that  analysis,  pushed  to  its  utmost  limits, 
degenerates  into  deceptive  subtilties.  A  great  number  of  physicians 
repeated  the  observations  of  Bordeu,  either  to  confirm  or  amend  his 
doctrine,  and  their  united  labors  carried  sphygmics,  toward  the 
middle  of  the  last  century,  to  a  very  high  degree  of  perfection.  At  the 
same  epoch,  a  modest  German  practitioner  gave  to  semeiotics  a  new 
means  of  investigation,  destined  to  acquire,  at  a  later  j^eriod,  a  major 
importance.  Leopold  Avenbrugger  published  at  Vienna,  in  17G1,  the 
result  of  his  experience,  with  the  title  of  New  Method  to  Recognise 
Internal  Diseases  of  the  Chest,  hy  the  Percussion  of  that  Cavity  fi  This 
discovery  was  not  much  noticed,  even  in  Germany,  though  Stoll  em- 
ployed it  and  eulogised  it.  Sprengel,  who  wrote  his  history  toward  the 
close  of  the  last  century,  speaks  of  it  as  follows:  "  1  must  also  mention 
another  sign,  which  was  discovered  by  Leopold  Avenbrugger,  and  which 
he  asserts  to  be  the  most  important  of  all  those  that  compose  semeiotic 
pathology  ;  it  is  the  sound  which  the  chest  gives  when  it  is  struck.  It 
is  impossible  to  deny  that  the  thorax,  struck  with  the  palm  of  the  hand, 
resounds  diflFerently  when  the  lungs  are  free  and  sound,  than  when  they 
are  adherent,  engorged,  or  ulcerated.  Avenbrugger  has  developed,  very 
well,  this  fact,  in  a  particular  treatise ;  but  he  does  it  with  a  little  too 
much  subtilty,  for  it  is  scarcely  credible  that  he  could  have  recognised 
the  various  diseases  of  the  lungs  and  chest  by  the  sole  percussion  of  that 
cavity.  Xevertheless,  his  observations  merit  to  be  read,  and  they  have 
been,  in  part,  confirmed  by  Isenflamm.f 

The  work  of  Avenbrugger  was  translated  into  French  by  Eosiere  de  la 
Chassagne  ;  but  his  method  of  exploration  was  almost  unknown  in 
France  until  it  had  been  vulgarised  by  the  lectures,  translations  and 
learned  commentaries  of  Corvisart.|  We  shall  see  it  in  the  end  receive 
an  extraordinary  extension  and  perfection  by  the  addition  of  another 
proceedure  not  less  ingenious,  designated  by  the  name  of  auscultation. 

We  find  in  the  Hippocratic  books  a  proceedure  which  has  some  rela- 
tion to  percussion.  It  consists  in  giving  the  shoulders  of  the  patient  a 
shake,  by  means  of  which  the  sound  of  a  liquid  effused  into  the  thoracic 
cavity  may  be  heard.  This  gross  proceeding,  termed  succussion,  appears 
to  have  been  abandoned  by  the  successors  of  the  Asclepiadse,  because  of 
its  uncertainty  and  the  great  inconvenience  of  its  employment. 

'■^  Inventur  novum  ex  percussione  thoracis  humani  ut  signo  abstrusos  interni 
pectoris  morbos  detegendi.     Vienne,  17G1. 

f  Hist,  de  la  Med.,  sec.  xv.,  cap  in.,  art.  v. 

I  See  translation  of  Avenbrugger's  work,  from  Latin  into  Frencli  by  Corvisart. 
Paris,  1808. 


418  REFORM   PERIOD. 

§  n.    Pathological  Anatomy. 

Pathological  Anatomy,  whicli  was  created  towards  the  middle  of  the 
preceding  period,  rapidly  grew,  and  formed  very  soon  a  considerable 
branch  of  pathology.  From  the  beginning  of  the  seventeenth  century 
a  great  number  of  physicians  devoted  themselves,  assiduously,  to  necro- 
scopy, and  by  their  labors  a  considerable  quantity  of  materials  was 
collected.  Among  the  collections  of  the  necroscopic  observations  of  this 
epoch,  we  distinguish  those  of  Thomas  Bartholin,  Nicholas  Tulpius, 
Dominic  Panaroli,  John  James  Wepfer,  Frederick  Ruysch,  John  Conrad 
Peyer  and  Stephen  Blancaerd.  These  materials  were  capable  of  shed- 
ding a  bright  light  on  the  seat  and  nature  of  a  certain  number  of 
diseases ;  but  they  were  lost  in  a  multitude  of  volumes.  In  order  to  be- 
come beneficial  to  science  it  was  necessary  to  collect,  examine,  and  classify 
them,  according  to  their  analogies,  to  deduce  from  them  the  consequences 
relative  to  the  diagnosis  of  diseases,  and  the  practice  of  medicine ; — an 
immense  task,  which  did  not,  however,  check  the  patient  zeal  of  The- 
ophilus  Bonet. 

This  writer  did  not  dissimulate  the  difficulties  of  his  project,  nor  the 
numerous  causes  of  imperfection,  inherent  to  a  first  effort  of  the  kind. 
He  appreciates  them,  on  the  contrary,  with  very  great  justness,  when  he 
says :  "  this  work  has  cost  me  as  much  fatigue  and  care  as  the  reader 
will  draw  advantage  from  it ;  for  1  hazard  myself  without  a  guide  on 
an  unknown  path,  where  there  is  no  perceptible  trace  of  man :  I  tread 
with  fear  this  long,  rude  and  difficult  path.  I  know,  he  continues,  how 
far  I  shall  fall  short  of  my  aim ;  but  I  hope  that  I  shall  receive  thanks 
for  having  taken  the  first  step  in  a  career  so  eminently  useful.* 

Bonet  divides  his  general  repertory  of  pathological  anatomy  into 
four  books.  In  the  first  he  collects  all  the  diseases  of  the  head :  in  the 
S3Cond  those  of  the  chest ;  in  the  third  those  of  the  abdominal  organs : 
lastly,  the  fourth  contains  observations  relative  to  diseases  whose  seat 
is  unknown,  or  which  may  attack  indifferently  all  parts  of  the  body, 
such  as  fevers,  gout,  syphilis,  tumors,  wounds,  etc. 

To  give  an  idea  of  the  quantity  of  matter  contained  in  this  work,  I 
shall  only  cite  one  example.  The  eighth  section  of  the  second  book  is 
devoted  to  the  exposition  of  the  causes  of  the  palpitations  and  pains  of 
the  heart.  The  following  is  an  enumeration  of  these  causes  according 
to  necroscopic  observations  reported  in  this  chapter:  a  tubercle,  an 
abscess,  excessive  heat,  sanguineous  plethora  occasioning  obstruction, 
worms,  sudden  evacuation,  pregnancy,  inflammation,  a  pouch  filled  with 

*  Sepulchretum  sive  anatomia  Practica.    Genevae,  1700. 


i 


INTERNAL   PATHOLOGY.  419 

water  or  some  putrid  liquid,  a  miasmatic  infection  whether  from  the 
exterior  or  interior,  and  certain  unnatural  adhesions.  These  causes 
exist  sometimes  in  the  cavities,  or  in  the  substance  even  of  the  heart, 
or  in  the  pericardium,  or  in  the  arteries ;  again,  they  are  in  more 
distant  parts,  as  the  uterus,  liver,  spleen,  or  stomach.  For  each  of  these 
cases  the  author  reports  one  or  several  clinical  observations,  accompanied 
with  the  opening  of  the  corpse.  There  are  at  least  forty,  relating  to 
pains  and  palpitations  of  the  heart. 

These  observations  have  been  complained  of  for  their  want  of  sufficient 
detail ;  some  of  them  for  not  being  sufficiently  authentic,  and  others  yet 
for  presenting,  as  causes  of  diseases,  certain  results  occurring  after  death. 
These  reproaches  are  well  founded,  and  it  must  be  agreed  that  this 
enormous  compilation  shone  more  for  the  labor  and  patience  of  its  pre- 
paration, than  for  its  invention  and  method ;  but  such  as  it  is,  it  con- 
stitutes, nevertheless,  an  era  in  the  history  of  pathological  anatomy — 
it  served  as  a  point  of  departure  for  ulterior  researches,  and  principally 
for  those  of  which  the  immortal  Morgagni  published  the  results,  nearly 
a  century  later. 

The  latter  indeed  did  not  propose,  in  composing  his  anatomo-patholo- 
gical  letters,  more  than  to  amend,  and  reconstruct  in  some  sort,  the  work 
of  Thcophilus  Bonet.  Profiting  by  the  riches  which  the  science  had 
acquired  in  this  interval,  and  especially  by  those  which  his  master 
Valsalva  had  collected;  joining  to  a  very  extensive  erudition  a  severely 
critical  habit,  he  established  order  and  clearness  where  the  author  of 
the  Sepulchretwn  had  left  obscurity  and  confusion  reigning.  He  showed 
himself  original,  without  making  any  pretension  to  it ;  in  contrast  with 
so  many  others  who  make  much  pretension,  without  doing  any  thing  of 
value.  He  does  not  disguise  what  he  borrows  from  others,  either  dead 
or  living ;  but  what  is  his  own,  is  the  choice  and  judicious  employment 
of  materials,  and  his  wise  and  luminous  discussion  of  facts.  Persuaded 
that  medical  science  cannot  go  forward  except  in  the  light  of  observa- 
tion, he  avoids  scrupulously,  turning  aside  into  the  vagueness  of  inter- 
pretations, so  that  no  one  could  apply  to  him  that  remark  of  Homer, 
which  he  himself  recalls  in  his  preface,  "  he  has  told  many  lies  in 
speaking  of  probabilities."     Odyss.  lib.  xix. 

The  following  selection  will  show  his  wise  and  circumspect  manner  of 
discussion  :  "  The  great  Senac,  it  is  said  in  the  twenty-third  letter, 
denies  the  absence  of  the  pericardium  ;  on  the  other  hand,  he  confirms 
by  multiplied  observations,  its  adhesion  to  the  heart ;  but  he  teaches  the 
nature  of  this  adhesion,  and  its  locality  when  it  causes  or  prevents  pal- 
pitations. Nor  does  he  any  more  conceal  how  much  care  must  be  taken, 
when  it  occurs  at  the  same  time  with  other  causes,  if,  above  all,  they 


420  REFORM   PERIOD. 

are  grave,  not  to  attribute  hastily  the  palpitation  to  adhesion ;  and  he 
asserts,  in  general,  that  when  several  causes  are  united  at  once, 
the  particular  effect  of  each  cannot  be  distinguished,  and  even  then,  all 
united  can  produce  certain  phenomena  to  which  no  one  in  particular 
could  give  rise."'-'' 

The  work  of  Morgagni  appeared  in  1762.  From  that  time  to  the  end  of 
the  eighteenth  century,  a  great  number  of  physicians  occupied  themselves 
with  anatomo-pathological  researches,  and  added  new  observations  to 
those  already  known.  Among  these  I  must  cite,  more  particularly,  Th. 
Walter,  P.  Barrere,  Santorini,  Edward  Sandifort,  Andrew  Bonn,  Gr. 
Hunter,  John  Ernest  Greding,  John  Baptiste  Palletta,  Joseph  Lieutaud, 
Anthony  Portal,  and,  above  all,  Xavier  Bichat,  who,  uniting  to  a  genius 
eminently  generalising,  an  admirable  talent  for  analysis  and  observation, 
shed,  not  only  on  pathological  anatomy,  but  on  the  whole  of  pathology, 
a  clear  light,  whose  rays  have  directed  the  labors  of  most  of  his  suc- 
cessors. The  idea  of  separating  the  human  body  into  elementary 
tissues,  which  present,  in  all  parts  wheie  they  are  found,  the  same 
properties,  and  are  subject  to  the  same  alterations,  was  a  mother  idea, 
which  has  now  for  fifty  years  served  as  the  basis  of  the  researches 
of  all  pathologists.  Bichat  comprehended  well  all  these  results,  and  he 
presents  them  clearly  and  justly: 

"  Chemistry,"  he  says,  "  has  its  simple  bodies  ;  these,  by  the  various 
combinations  of  which  they  are  susceptible,  form  compound  bodies ;  such 
are  caloric,  light,  hydrogen,  oxygen,  carbon,  azote,  etc.  So,  also,  anato- 
my has  its  simple  tissues,  which  by  their  combination — four  to  four,  six  to 
six,  eight  to  eight,  etc. — form  the  organs.  These  tissues  are  :  first,  the 
cellular ;  second,  the  nervous  system  of  animal  life  ;  third,  the  nervous 
system  of  organic  life  ;  fourth,  the  arterial  system,  etc.  Here  are  seen 
the  veritable  organised  elements  of  our  parts.  Wherever  they  are  met 
with,  their  nature  is  constantly  the  same,  just  as,  in  chemistry,  the  simple 
bodies  do  not  vary,  whatever  may  be  the  compound  into  which  they 
enter. 

"  The  idea,  too,  of  considering  thus  abstractly  the  different  tissues  of 
our  organs,  is  not  an  imaginary  conception,  it  rests  on  real  foundations, 
and  I  believe  will  have  a  powerful  influence  on  physiology  and  medical 
practice.  In  fact,  from  whatever  point  of  view  these  tissues  are  studied, 
they  do  not  at  all  resemble  each  other.  It  is  nature,  and  not  science, 
which  has  drawn  the  line  of  demarkation  between  them."  f 

"  Twenty-third  Lettre  Anat.-Med.,  translated  by  Doctor  Destonet.   Paris,  1820. 

f  Anatomie  Generale,  edition  of  Beclard  and  Blandin. — Paris,  1881.     Compare 

J.  Henle,  Traite  d' Anatomie  Generale,  translated  by  J.  L.  Jourdan. — Paris,  1843, 


IjH  INTERNAL   PATHOLOGY.  421 

A  little  farther  on  he  cadds :  "  I  divide  pathological  anatomy  into 
two  great  parts.  The  first  includes  the  history  of  the  alterations  com- 
mon to  each  system,  whatever  may  be  the  organ  or  region  in  which  this 
structure  is  found.  It  is  necessary  to  show,  in  the  first  place,  the 
various  alterations  of  cellular,  arterial,  venous,  osseous,  nervous,  mus- 
cular, and  other  tissues ;  to  examine  the  mode  of  inflammation,  suppu- 
ration, gangrene,  etc.,  proper  to  each  of  them ;  to  speak  of  the  various 
tumors  of  which  they  are  susceptible,  the  changes  in  structure  which 
they  realise,  etc.  After  having  thus  indicated  the  alterations  proper  to 
each  system,  in  whatever  organ  they  are  found,  it  is  necessary  to  re- 
sume the  examination  of  the  diseases  appertaining  to  each  region — to 
examine  those  of  the  head,  the  chest,  the  abdomen,  and  the  members 
following  their  ordinary  course.  This  progress  is  incontestibly  the  most 
natural,  although,  as  in  all  the  divisions  by  which  man  tries  to  bring 
nature  within  his  conceptions,  there  are  many  points  to  which  they  do 
not  apply." 

We  thus  see  that  in  setting  forth  the  advantages  of  the  innovations 
which  he  proposes,  Bichat  neither  disguises  the  difficulties  nor  the  abuses 
to  which  it  may  lead.  "Do  not  esagerate,"  he  said,  previously,  "this 
independent  relation  which  the  tissues  of  an  organ  hold  to  each  other 
in  regard  to  diseases  ;  practice  would  contradict  us.  We  now  often  see 
that  the  cellular  tissue  is  the  means  of  communication,  not  only  between 
two  tissues  of  the  same  organ,  but  also  between  different  organs.  Thus, 
in  many  chronic  diseases,  are  the  tissues  of  the  same  organ  gradually 
altered,  and,  at  the  opening  of  the  body,  the  totality  of  the  organ  ap- 
pears to  be  affected,  although  a  single  tissue  was  originally  diseased. 
In  cancer  of  the  breast  a  small  tumor  is  moveable,  at  first,  under  the 
finger ;  in  the  end  the  whole  glandular,  cellular,  and  even  cutaneous 
tissues,  are  confounded  in  a  common  and  cancerous  mass.  The  cancer 
of  the  stomach,  intestines,  etc.,  presents  the  same  condition.""  I  have 
permitted  myself  to  quote  thus  much  on  these  points,  because  it  shows 
the  true  route  pathological  anatomy  must  follow,  and  because  it  proves, 
at  the  same  time,  that  this  branch  of  the  science  can  not  be  separated 
from  clinical  observation  without  losing  much  of  its  importance  and 
utility. 


§  in.    NOSOGRAPHT. 

It  is  impossible  to  construct  a  descriptive  table  of  all  diseases,  or 
even  of  a  small  number,  without  adopting  some  order — some  species  of 

**  Anatomic  Gcnerale,  §vii. 


422  REFORM   PERIOD. 

nosological  classification.  We  have  shown  that  the  outlines  of  such  a 
plan  are  to  be  seen  in  the  works  of  the  Asclepiadse.  In  that  collection, 
diseases  are  sometimes  divided  into  sporadic,  epidemic,  and  endemic, 
and  sometimes  into  acute  and  chronic ;  but  the  authors  who  first  made 
these  divisions  did  not  adhere  to  them  strictly,  at  least  from  what  we 
may  judge  from  the  fragments  that  form  the  Hippocratic  collection.  It 
was  only  after  the  foundation  of  the  school  at  Alexandria,  and  as  the 
result  of  the  influence  of  the  Peripatecian  philosophy,  that  the  savaus 
in  general,  and  physicians  in  particular,  devoted  themselves  to  arrang- 
ing, in  a  more  systematic  manner,  the  subjects  they  had  to  treat. 

The  order  most  generally  adopted  by  the  ancient  nosographers,  was 
called  the  anatomical,  and  consists  in  classifying  diseases  according  to 
the  portions  of  the  body  afiecte(il  Thus,  it  was  customary  to  divide  all 
the  morbid  afifections  into  internal  or  external,  or  which  follows  the 
same  plan,  into  medical  and  chirurgical — a  bad  distribution,  which  every 
one  blames,  but  which  exists  still  in  most  of  the  treatises,  and  we  have 
consequently  been  obliged  to  preserve  it.  Then,  internal  diseases  were 
divided  into  general  and  special.  The  first  class  comprised  diseases 
which  seem  to  affect  the  whole  system,  not  having  any  particular  seat, 
such  as  essential  fevers,  gout,  syphilis,  poisons,  etc.  The  second  class 
comprised  affections  whose  seat  is  in  one  of  the  three  splanchnic  cavities, 
the  head,  chest,  or  abdomen.  There  exists  still  another  classification, 
famous  in  antiquity — that  of  the  Methodists,  which  we  have  explained 
at  length,  and  which  we  will,  therefore,  not  repeat.  Lastly,  some 
authors  have  divided  diseases  according  to  the  age,  sex,  climate,  etc., 
but  their  divisions  have  only  been  adopted  in  special  treatises,  and  for 
particular  views,  with  which,  at  present,  we  can  not  occupy  ourselves. 
It  will  be  only  required  here  to  give  such  classifications  as  were  adopted 
in  the  general  treatises,  embracing  the  totality,  or  greater  part  of  known 
diseases. 

We  have  said  a  word  on  the  classification  proposed  by  Felix  Plater, 
at  the  end  of  the  sixteenth  century.  It  does  not  appear  that  it  exercised 
a  great  influence,  for  we  see  a  long  time  after,  such  medical  authors  as 
Sennet,  Eiviere,  Morgagni,  and  others,  follow  the  old  method.  Never- 
theless, toward  the  close  of  the  seventeenth  century,  an  illustrious 
practitioner  of  England,  Thomas  Sydenham,  expressed  a  desire  to  see 
composed  a  history  of  diseases,  which  would  be  free  from  all  hypothesis,  in 
which  the  sole  effort  should  be  made  to  trace  with  exactness  the  sensible 
phenomena,  and  to  distinguish  the  morbid  species  by  their  essential  and 
constant  symptoms.  At  that  epoch,  all  the  branches  of  natural  history 
had  gained  high  ground,  and  acquired  a  precision  till  that  time  un- 
known, thanks  to  the  perfection  of  systematic  classifications  introduced 


INTERNAL  PATHOLOGY.  423 

into  science.  The  naturalists  had  attained  such  skill  as  to  distribute 
all  beings  which  were  the  objects  of  their  study,  into  classes,  orders, 
genera,  and  sj^ecies,  separated  from  each  other  by  well-marked  and 
invariable  characters,  by  means  of  which,  it  was  easy  to  distinguish  the 
different  species,  notwithstanding  their  multitude.  Medical  men  flat- 
tered themselves,  that  if  they  employed  an  analogous  method,  they 
would  be  able  to  diagnosticate  diseases  with  the  same  precision  and  cer- 
tainty, as  a  botanist  recognises  and  names  a  vegetable. 

Boissier  Sauvages,  a  physician  of  Montpelier,  scarcely  twenty-four 
years  of  age,  conceived  a  plan  of  nosography  formed  on  this  model.  He 
conferred  with  the  great  Boerhaave,  who  approved  of  it,  without  con- 
cealing from  him,  however,  the  extreme  difficulties  of  its  execution. 
But  the  young  man,  more  emboldened  by  such  suffrage  than  frightened 
by  the  obstacles  which  were  presented,  pursued  his  project,  and  a  few 
years  after,  in  1732,  he  published  a  first  rough  draft,  with  the  title  of 
"  Xew  Classes  of  Diseases,  arranged  in  an  order  similar  to  those  of  the 
Botanist."  This  essay  produced  only  a  moderate  sensation  ;  but  thirty 
years  later,  when  the  author  published  the  same  work,  with  the  title  of 
NosoLOGiE  Methodique,  but  entirely  remodeled,  and  considerably  aug- 
mented, the  attention  of  all  Europe  was  keenly  excited.  The  renown 
of  Sauvages,  already  great,  was  carried  to  its  height,  and  what  proves 
best  the  extraordinary  vogue,  as  well  as  esteem,  which  the  Nosologic 
Methodique  enjoyed,  is,  that  the  learned  Linnaeus  used  no  other  work  in 
his  course  at  the  University  of  Upsal,  for  the  space  of  twenty  years. 

Whatever  may  be  the  discredit  into  which  has  now  fallen  that  spe- 
cies of  composition,  the  Xosologie  Methodique  of  Sauvages  will  always 
be  worthy  of  the  regard  of  whoever  loves  to  follow  the  march  and 
development  of  a  science  as  difficult  as  pathology.  Besides  that,  it 
offers,  as  the  first  link  of  a  series  of  interesting  productions,  the  most 
complete  collection  of  diseases  described  up  to  that  time,  and  of  obser- 
vations collected  from  all  parts.  I  will  now  give  an  extract  from  it ; 
according  to  Chaussier,  Pinel,  and  Bricheteau/-' 

Diseases  were  divided  by  Sauvages  into  ten  classes,  forty-four  orders, 
three  hundred  and  fifteen  genera,  and  nearly  two  thousand  four  hundred 
species. 

1st  Class.  Imperfections,  (Vices) ;  Superficial  or  cutaneous  affec- 
tions, the  most  of  which  are  susceptible  of  being  cured  by  local  and 
mechanical  means. 

2d  Class.     Fevers;    Commencing  with  shivering,  followed  by  heat 

^Dictionaire  des  Sciences  Medicales,  at  the  word  Nosography;  also  the  Table 
des  M^thodes  Nosologiques,  of  Chaussier. 


424  REFORM   PERIOD. 

and  sweat,  with  a  frequent  pulse,  general  pains,  feebleness,  prostration, 
and  oppression  of  tlae  forces. 

3d  Class.     Inflammations;  Local  phlegmasia  with  .symptomatic  fever. 

4th  Class.  Spasms ;  Convulsive  diseases,  permanent  or  periodical 
contraction  of  the  muscles  of  locomotion. 

5th  Class.  Anhelations ;  Difficult  respiration,  spasm  of  the  chest, 
without  acute  fever. 

6th  Class.  Dehility ;  Inability  to  feel  distinctly,  to  act  or  execute 
the  movements  or  functions  with  the  accustomed  energy. 

7th  Class.  Pains;  General  or  local,  uneasiness,  not  caused  by 
phlegmasias. 

8th  Class.  Vesania,  or  Insanity ;  Lesions,  more  or  less  profound,  of 
the  faculties  of  the  mind. 

9th  Class.  Flux  ;  Accidental  excretion,  more  or  less  considerable,  of 
fluids  variously  colored. 

10th  Class.  Cachexias;  Depravation  or  alteration  in  the  form, 
color,  and  volume  of  parts. 

Notwithstanding  the  veneration  that  Sauvages  professed  for  Syden- 
ham, whom  he  names  the.  glory  of  England,  and  the  Light  of  our  Art. 
he  has  not  strictly  followed  the  counsel  given  by  that  physician,  to 
write  the  history  of  diseases  without  mingling  with  it  any  theoretic 
explanation  or  hypothesis.  The  theory  which  Sauvages  wished  to  estab- 
lish was  a  mixture  of  the  ideas  of  Boerhaave  with  those  of  Stahl,  of 
which  we  shall  speak  hereafter.  What  I  wish  to  remark  at  this  time 
is,  the  inclination  of  medical  writers  to  decry,  in  the  outset,  all  theories, 
to  demonstrate  their  falsity  and  danger,  and  immediately  propose  one  of 
their  own,  as  being  alone  founded  in  reason. 

"  There  has  not  existed,"  says  Sauvages,  "  up  to  the  present,  any  con- 
nection between  theory  and  practice ;  the  latter  is  acquired  by  tradi- 
tion, and  no  one  has  confidence  enough  in  his  theoretical  principles  to 
follow  them  blindly,  when  the  life  of  a  man  is  at  stake.  The  three 
principal  laws  of  nosology,  dictated  by  wisdom  itself,  are :  First,  make 
an  exact  and  purely  historical  division  of  the  species  and  genera  of  dis- 
eases ;  second,  distinguish  philosophic  theory  or  hypothesis  from  history ; 
third,  establish  the  characters  of  diseases,  on  their  constant  symptoms." 

A  little  further  on,  after  having  shown  the  diflFerence  that  exists 
between  the  philosophic  knowledge,  which  he  names  also  etiology,  and 
the  purely  historical  and  descriptive  knowledge,  he  gives  the  preference 
to  the  first,  in  these  terms  :  "  Philosophic  knowledge  aids  the  historical, 
opens  the  way  to  mathematical   knowledge,   and  fills  the  mind  with 

"  Nosol.  Method. 


INTERNAL   PATHOLOGY.  425 

agreeable  sensations.  Happy  he  who  understands  the  origin  of  things ! 
Philosophic  nosology,  therefore,  is  useful  to  physicians,  and  preferable  to 
the  historic.  It  distinguishes  the  Dogmatists  from  the  Empirics,  with 
whom  all  science  consists  in  the  historic  knowledge  of  diseases.  But 
where  philosophic  nosology  is  eiToneous,  and  founded  on  false  principles, 
we  must  give  preference  to  simple  historic  nosology ;  for  it  is  much 
better  to  have  no  etiology  than  to  accept  a  false  one,  which  would  only 
serve  to  lead  physicians  into  grievous  errors."" 

How  strange,  that,  after  having  so  clearly  set  forth  the  temerity  there 
is  in  engaging  in  a  search  for  the  proximate  causes  of  diseases,  this  author 
yet  dares  adventure  in  the  pursuit  of  this  chimera !  Such  is,  never- 
theless, the  inconsistency  of  Sauvages,  and  of  nearly  every  writer  in 
Medicine.  Whatever  there  is  of  interest,  to-day,  in  the  work  of  the 
first  of  nosologists  ( and  there  is  much )  it  is  certainly  not  applicable  to 
the  department  of  etiology,  which  has  so  much  changed  since  his  time ; 
but  much  rather  to  the  descriptive  part,  which  has  but  slightly  changed, 
notwithstanding  the  progress  of  science. 

AVhen  the  enthusiasm  and  astonishment  excited  by  the  novelty  of 
this  production,  were  somewhat  cooled  down,  criticism  had  its  turn.  It 
was  shown  that  the  genera  and  species  were  too  gi-eatly  multiplied, 
throwing  diagnosis  into  confusion,  and  so  much  the  more,  as  they  were 
not  always  separated  from  each  other,  by  symptoms  sufficiently  well 
defined  and  constant.  Other  faults  were  also  pointed  out,  more  or  less 
real.  Then  a  great  number  of  physicians  exerted  themselves  to  trace 
other  nosological  classifications,  which  they  believed  to  be  more  perfect, 
because  they  had  not  yet  submitted  them  to  criticism.  Each  professor 
was  anxious  to  have  his  own,  and  to  attach  to  it  his  name ;  but  as  the 
greater  number  of  these  productions  only  differed  from  each  other  in  a 
few  variations,  I  shall  dispense  with  reporting  them ;  and,  I  therefore, 
pass  at  once  to  that  of  CuUen,  which  appeared  in  1772,  and  which  con- 
stitutes a  veritable  progress. 

The  nosology  of  William  Cullen,  professor  in  the  University  of  Edin- 
burgh, embraces  four  classes;  nineteen  orders;  two  hundred  and  thirty 
genera ;  and,  less  than  six  hundred  species : 

1st  class.  Pyrexice:  Frequent  pulse,  shivering,  augmentation  of  heat, 
debility  of  the  animal  functions. 

2nd  class.  Neuroses  :  Nervous  affections,  lesions  of  sensation  and 
motion,  without  pyrexia,  or  local  disease. 

3rd  class.      Cachexice:     Depravation  of  the   natural   state  of  the 

«»  Nosol.  Method. 
27 


426  REFORM   PERIOD. 

system,  or  of  a  considerable  portion  of  it;  without  primitive  pyrexiae 
or  neuroses. 

4th  class.  Locales :  Affections  of  a  part  of  the  body,  the  organic 
affections  of  authors.  This  last  is,  according  to  the  framer,  the  most 
irregular  of  all,  and  purely  surgical. 

In  this  classification,  as  we  see,  the  orders,  genera  and  species,  arc 
considerably  reduced ;  they  are  besides,  distinguished  from  each  other 
by  characters  better  defined  and  less  variable.  It  presents,  then,  a  real 
improvement  on  that  of  Sauvages  ;  it  also  obtained  a  universal  vogue, 
which  it  maintained  till  the  publication  of  the  Nosographie  Philoso- 
phique,  of  Ph.  Pinel,  in  1798, 

This  eclipsed  all  others,  and  became  classic  throughout  Europe.  Six 
successive  editions,  in  the  space  of  twenty  years,  shows  the  confidence 
it  enjoyed.  During  this  long  period,  it  underwent  some  revisals,  of 
which  I  shall  say  but  little,  because  it  belongs  to  the  history  of  the 
nineteenth  century,  and  I  shall,  therefore,  refer  to  the  first  edition  only. 

All  the  preceding  nosologists  had  embraced,  in  their  classifications, 
internal  and  external  diseases  ;  but  they  included  the  last  for  mere 
form  only,  and  gave  them  but  a  very  succinct  and  very  insufficient 
description,  to  which  the  Surgeons  paid  no  attention.  Pinel  did  not 
follow  this  plan,  and  was  unwilling  to  comprise,  in  his  classification,  only 
the  internal  aff"ections  or  those  from  internal  causes,  though  he  does  not 
dissimulate  how  vague  and  inexact  the  line  of  demarkation  is,  which  is 
pretended  to  be  drawn  between  diseases  from  an  internal  or  external 
cause.  He  avows,  that  there  exist  numerous  intermediary  species 
which  may  be  called  medico-chirurgical,  the  position  of  which  it  is 
excessively  difficult,  if  not  impossible,  to  determine.  iS'otwithstand- 
ing  these  defects,  he  believed  it  right  to  preserve  the  division  of 
pathology  into  internal  and  external. 

Consequently,  he  divided  diseases  which  he  regarded  as  internal,  into 
six  classes,  twenty-one  orders,  and  eighty-four  genera,  as  follows  : 

1st  class — Fevers :  Frequent  pulse,  increase  of  heat,  lesions  in  most 
of  the  pulsations,  fixed  duration,  etc. 

2d  class — Phlegmasice:  Local  pain,  heat,  and  redness,  with  or 
without  the  febrile  state,  terminating  by  resolution,  suppuration,  gan- 
grene, or  induration. 

3d  class — Active  Hemorrhages  :  Effusions  of  blood  fi'om  the  surface 
of  mucous  membranes,  and  other  tissues. 

4th  class — Neuroses :  Lesions  of  sensation  and  motion,  without 
inflammation  or  alteration  of  structure. 

5th  class — Diseases  of  the  Lymphatic  and  Dermoid  Systems. 


rNTERNAL   PATHOLOGY.  427 

6th  class — Undetermined  Diseases :  Comprising  the  genera  which 
are  not  e':ough  rehited  to  each  other  to  form  general  orders.--^ 

The  historian  Kurt  Sprengcl,  who  wrote  at  the  commencement  of  the 
ninteenth  century,  speaks  of  the  Philosophic  Nosography,  and  its  author, 
in  the  following  terms:  "  Faithful  to  nature  and  experience,  like  Hippo- 
crates, whom  he  took  constantly  for  a  model,  and  cultivated  by  the  pro- 
found study  of  the  best  medical  works  published  in  all  time,  Pinel  ranks 
among  the  most  skillful  and  learned  physicians  of  our  day.  His  book  is 
a  veritable  chef  d'ceuvre,  both  on  account  of  the  excellent  plan  he  has 
adojjted,  and  by  reason  of  the  depth  and  impartiality  of  his  judgment." 

The  Nosography  of  Pinel  oiFers  numerous  differences  to  that  of  Cullen. 
of  which  the  following  are  the  most  important :  The  Scotch  nosologist 
has  united  in  the  same  class,  under  the  head  of  pyrexiae,  fevers,  inflam- 
mations, and  hemorrhage,  while  the  French  nosographer  has  divided  these 
affections  into  three  classes.  The  first  distinguishes  fevers  either  after 
their  type  or  proximate  cause ;  the  second  considers  the  totality  of  their 
symptoms,  and  the  organs  which  they  seem  principally  to  affect.  ConsC' 
quently  he  admits  an  order  of  angiotenic  or  inflammatory  fevers,  which 
he  believes  derived  from  the  primitive  excitation  of  the  organic  forces  of 
the  vascular  system — an  order  of  meningo-gastric  or  bilious  fevers,  pro- 
ceeding from  a  primitive  affection  of  the  membranous  system  of  the 
primce  vice,  etc.  In  regard  to  phlegmasia  and  hemorrhage,  Pinel  distin- 
guishes them,  also,  according  to  the  tissues  where  they  are  seated.  This 
was  an  important  innovation  and  happy  thought,  which  has  been  made 
more  fruitful,  as  before  said,  by  the  genius  of  Bichat,  in  his  Anatomic 
Generale,  and  has  shed  upon  pathology  a  clear  light,  and  introduced  a 
new  order  of  things. 

Among  the  uosologists  who  appeared  before  the  close  of  the  eighteenth 
century,  and  of  whom  we  have  not  yet  made  account,  we  shall  cite,  as  a 
memoir  only,  and  following  their  chronological  order,  first,  the  classifica- 
tion of  Linnaeus,  which  closely  resembles  that  of  Sauvages,  and  was 
published  twenty  years  later  ;  second,  the  Prcelectiones  de  Cognoscendis 
et  Curandis  Morbis  Prcecipius  corporis  Hiimani  Affectibus,  of  E.  A. 
Vogel,  professor  at  Gottingen ;  third,  the  classification  proposed  by  David 
Macbride,  an  Irish  physician,  in  his  Methodic  Introduction  to  the 
Theory  and  Practice  of  Medicine ;  fourth,  that  of  Melchior  Sagar, 
based  almost  entirely  on  that  of  Sauvages  ;  fifth,  the  Xosological  Table 
of  Louis  Vitet,  which  may  be  found  in  his  Treatise  on  Materia  Medica ; 

^  la  the  sixth  edition,  these  two  classes  have  been  reduced  to  one,  under  the 
title  of  Organic  Lesions. 


428  REFORM     PERIOD. 

sixth,  that  of  Erasmus  Darwin,  published  under  the  title  of  Zoonomia, 
and  remarkable  for  its  originality,  and  the  poetical  imagination  of  its 
author,  much  more  than  for  its  severity  of  anal^'sis  and  exactness  of 
observation ;  seventh,  and  lastly,  the  essay  of  a  general  classification  of 
diseases,  presented  by  Selle  at  the  end  of  his  Pyrethologie  Methodique ; 
an  essay  which  does  not  respond  to  the  reputation  of  its  author,  and 
which  he  did  not  finish. 

Sauvages  after  having  examined  at  length,  in  his  Prolegomena,  what 
should  be  the  basis  of  a  good  nosology,  concluded  with  Sydenham,  that 
it  should  be  based  only  upon  the  constant  phenomena  and  sensible 
characters  of  diseases.  Nevertheless  he  did  not  unite  example  to  pre- 
cept, as  we  have  before  said,  for  he  does  not  fail  to  seek  the  principles 
or  causes  which  constitute  the  essence  of  each  disease.  Let  us  see,  for 
example,  what  he  says  on  the  subject  of  fevers:  "the  cause  of  fever  is 
the  distribution  of  the  nervous  fluid  or  forces,  greater  in  the  nerves  of 
the  heart,  than  in  the  nerves  of  the  members.  This  unequal  distribu- 
tion is  made  to  destroy  the  obstacles  which  oppose  the  circulation  of 
the  blood  in  the  capillary  vessels,  to  disembarrass  the  sanguineous  ves- 
sels, and  re-open  a  passage  for  the  blood.  The  heart  and  the  arteries 
are  the  principal  agents  in  fever."  All  the  other  nosologists,  not 
excepting  the  sage  Pinel,  have  fallen  into  the  same  contradiction,  that 
is  to  say,  after  having  blamed  loudly,  the  research  after  occult  causes — 
are  themselves  subsequently,  insensibly  led  into  this  research,  under 
some  pretext  or  other. 

One,  alone,  perhaps,  forms  an  exception  to  this  general  statement. 
This  was  Joseph  Lieutaud,  physician  of  Louis  XYL,  and  author  of  an 
anatomo-pathological  compilation,  which  we  have  before  mentioned. 
M.  Dezeimeris  expresses  himself  as  follows,  on  the  subject  of  his  treatise 
on  Practical  Medicine  :  "  this  is  the  best  work  of  the  last  century,  and 
nearly  the  only  one,  up  to  a  period  very  near  our  own,  in  which  we  find 
an  author  untrammeled  by  any  system,  consulting  more  the  phenomena 
furnished  by  observation,  at  the  bed  side  and  in  the  amphitheatre,  than 
the  oft  repeated  opinions  of  books ;  and  not  seeking  to  fill  by  hypotheses 
the  vacancies  which  experience  has  permitted  to  exist  in  the  science. 
Most  of  the  defects  of  this  remarkable  work  may  be  refcred  to  its 
brevity ;  the  author,  from  having  sought  to  be  short,  is  often  too  con- 
densed, incomplete,  and  obscure  for  a  reader  who  is  not  sufficiently 
instructed.  These  same  defects  are  carried  to  a  still  higher  degree,  and 
have  destroyed  the  utility  of  another  work  of  Lieutaud,  of  which  the 
object  was  certainly  the  most  important  which  could  have  been  chosen 
during  the  last  century :  I  mean  the  treatise  on  pathological  anatomy, 
in  which  Lieutaud  undertakes  to  comprise  all  that  had  been  learned  up 


INTERNAL  PATHOLOGY.  429 

that  time,  on  the  seat  and  causes  of  diseases,  by  autopsy.  The  object 
is  missed  for  the  most  part,  because  the  history  of  the  symptoms  of 
diseases  is  nearly  always  cut  short — the  description  of  the  alteration 
of  the  organs  often  insufficient ;  and  because  one  can  only  with  great 
difficulty  fill  its  vacancies,  owing  to  the  absence  of  all  references  to  the 
sources  whence  the  facts  were  drawn.  "••- 

In  his  Precis  de  Medicine,  Lieutaud  has  followed  the  anatomical 
order  as  much  as  he  possibly  could ;  for  he  says  there  are  many  diseases, 
on  which  the  opening  of  the  body  teaches  us  nothing,  and  it  is  good 
not  to  loose  sight  of  this  fact,  in  order  not  to  regard  as  an  omission  the 
silence  which  I  maintain  on  this  subject,  in  several  articles.  As  to  the 
research  of  occult  causes,  he  was  sensible  enough  not  to  engage  in  them, 
and  gives  the  following  excellent  reason;  "  as  I  have  not  been  willing 
to  bring  into  this  collection  any  hypotheses,  1  have  not  paused  to  con- 
sider the  immediate  and  proximcite  causes  exposed  with  so  much  vanity 
and  presumption  in  books,  though  always  impenetrable ;  but  I  have 
mentioned  those  that  are  termed  evident  and  remote,  which  may  unveil 
with  much  less  ambiguity  the  character  of  diseases." 

These  are  sentiments  worthy  of  all  approbation,  and  we  can  not  too 
much  praise  those  authors  who  have  remained  faithful  to  them.  But  it 
does  not  suffice  to  avoid  hypotheses  in  a  nosology:  it  is  also  necessary, 
and  this  is  capital,  to  give  exact  and  detailed  descriptions  of  each  mor- 
bid species.  Too  much  brevity  in  the  description  of  diseases  causes 
obscurity,  which  is,  after  error,  the  greatest  defect  in  a  work  of  this 
kind.  The  classifications  may  vary  infinitely,  because  they  depend  on 
the  manner  in  which  an  author  surveys  his  subject,  and  as  diseases  are 
very  complicated  subjects,  they  may  be  considered  in  a  great  number  of 
aspects,  but  the  description  of  each  morbid  species,  when  well  made, 
preserves  its  value,  independent  of  all  changes  of  classification  and  sys- 
tem. This  is  seen  in  some  of  the  description  of  Hippocrates,  Aretaeus, 
Alexander  de  Tralles,  and  all  great  observers.f 

^  Dietionnaire  Histor.  de  Med.     Art.  Lieutaud. 

fAt  the  moment  of  correcting  this  leaf,  I  am  put  in  possession  of  the  new 
work  of  Professor  Bouillaud,  entitled.  Traits  de  Nosographe  3fedicale,  Paris,  1846, 
5  vol.  8vo.  A  work  of  this  importance,  by  a  clinical  teacher,  and  a  profound 
observer,  like  M.  Bouillaud,  can  not  fail  to  fix  the  attention  of  the  medical  world; 
besides,  I  think  I  ought  to  exhibit  the  plan  adopted  by  the  author  in  his  nosolog- 
ical treatise.  This  work  is  divided  into  Twelve  Classes  of  Diseases,  viz. ; —  Class  I, 
fevers  and  inflammations,  or  pyrexiae. —  Class  II,  affections  consisting  in  a  want 
of  vital  excitation  ;  appendix,  excess  and  defect  of  hajmatosis. —  Class  III,  ataxias 
of  the  nervous  centers. —  Class  IV,  miasmatic  and  virulent  diseases. —  Class  V, 
heterotrophic.heterocrinic,  and  heterogenctic  diseases,  not  originating  from  inflam 
mation. —  Class  VI,  effusions  in  general,  and  effusions  of  blood  or  hemorrhage,  in 


430  REFORM    PERIOD. 

CHAPTER    V. 
INTERNAL    THERAPEUTICS. 

I  EXAMINED,  in  the  preceding  period,  the  ancient  therapeutical  axiom, 
diseases  are  cured  by  their  contraries,  and  the  result  at  which  we 
arrived  was,  that  this  axiom  neither  clears  up  nor  explains  anything  in 
many  cases,  and  that  in  others,  it  is  in  flagrant  contradiction  to  the 
facts.  I  concluded,  therefore,  that  it  should  be  erased  from  therapeutics, 
at  least  as  a  general  axiom,  if  we  wished  to  rest  this  science  on  a  solid 
basis,  whose  certainty  no  one  could  contest.  During  the  present  period, 
the  same  principle  appears  under  new  forms ;  at  the  same  time  other 
axioms  will  be  proclaimed,  concurrently  with  it,  some  of  which  are  con- 
nected with  the  ancient  doctrines,  others  with  those  that  are  entirely 
modern ;  but  as  all  the  general  principles  of  therapeutics  are  derived, 
without  exception,  from  some  cotemporary  physico-pathological  system, 
we  shall  exhibit  them  conjointly  with  those  systems,  and  submit  them 
to  a  thorough  examination.  Consequently,  we  shall  not  discuss  them  in 
this  chapter,  and  only  speak  for  the  moment  of  a  small  number  of  mate- 
rial conquests  of  therapeutics,  of  some  evident  ameliorations  attained  in 
the  treatment  of  certain  diseases,  the  utility  of  which  is  incontestible, 
and  whose  merits  are  independent  of  all  theory. 

TREATMENT   OF   SYPHILIS. 

We  have  seen  the  venereal  disease,  taking  the  place  of  the  leprosy  of 
the  middle  ages,  extend  its  ravages  with  a  frightful  rapidity,  and  throw 
the  people  into  a  terror  nearly  equal  to  that  which  its  predecessor  had 
inspired.  The  learned  physicians  sought  in  vain,  in  the  Greek  authors, 
the  means  to  combat  this  scourge  ;  such  as  they  found  there  were  perfectly 
inefiicacious.  The  surgeons,  on  the  contrary,  who  had  borrowed  from 
the  Arabs  certain  mercurial  preparations,  which  they  emj^loyed  against 
tetters,  were  naturally  influenced  to  make  a  trial  with  the  same  prepa- 
rations against  venereal  pustules.  The  success  that  they  obtained 
encouraged  them  to  persist  in  their  use.     The  celebrated  anatomist, 

particular. — Class  VII,  solutions  of  continuity,  and  abnormal  communications. 
Class  VIII,  changes  in  position  and  direction,  or  displacements  and  deviations. 
Class  IX,  adhesions,  connections,  and  abnormal  insertions. —  Class  X,  changes  in 
extension,  volume,  and  capacity. —  Class  XI,  foreign  and  retained  bodies. —  Class 
XII,  changes  in  respect  to  form,  number,  and  existence  of  organs,  and  their 
constituent  parts. 


INTERJSTAL  THERAPEUTICS.  431 

Berenger  de  Carpi,  was  the  first  who  prescribed  mercurial  frictions  with 
discretion,  and  watched  their  effects.  He  effected,  by  this  medication, 
numerous  cures.  Before  him,  Conrad  Gilinus  had  made  known,  in  the 
year  1499,  the  composition  of  an  ointment,  in  which  quicksilver  formed 
the  fourteenth,  and  the  bi-chloride  the  twenty-eighth  part.  Gaspard 
Torella,  physician  to  the  pope  Alexander  VI.,  and  of  his  son,  Caesar 
Borgia,  to  whom  he  dedicated  his  work  on  the  pox,  in  1499,  also  makes 
mention  of  a  mercurial  ointment. 

This  ointment  was  the  first  mercurial  preparation  used  in  Medicine, 
and  for  a  long  time  no  other  was  known.=-''  An  old  prejudice  opposed 
the  internal  administration  of  any  composition  of  which  quicksilver 
formed  a  part,  because  this  metal  was  regarded  as  a  virulent  poison. 
Paracelsus  was,  perhaps,  the  first  one  who  had  the  boldness  to  admin- 
ister it  in  this  way.  He  says  that  he  did  not  consider  mercury  as  a  real, 
efficacious  anti-venereal,  and  exempt  from  all  danger,  only  when  taken 
in  this  way  ;  and  corrosive  sublimate  was  thought  to  form  a  part  of 
some  of  his  numerous  secret  formulae.  . 

Besides,  under  whatever  form  and  by  whatever  way,  mercurial  salts 
are  administered,  their  employment  requires  precautions  that  were  not 
then  known.  On  this  account,  formidable  accidents,  such  as  dysente- 
ries, profuse  and  obstinate  salivations  that  exhaust  the  patient,  convul- 
sions, paralyses,  and  mortal  consumptions,  were  often  observed  in 
persons  who  had  used  mercurials.  Such  grave  accidents  following  a 
mercurial  treatment,  most  physicians  abandoned  it,  and  it  fell  into  the 
hands  of  greedy  charlatans,  ignorant  medicasters,  and  alchymists,  who 
employed  it  without  stint  or  precaution,  after  the  example  and  faith  of 
Paracelsus,  and  thus  brought  it  into  discredit. 

At  the  same  time,  it  was  supposed  that  other  means  of  healing,  less 
dangerous,  and  not  less  sure,  were  found.  The  decoction  of  the  wood 
of  guaiacum  produced  excellent  effects  on  many  patients  who  had  made 
abuse  of  hydrargyric  preparations.  Thus  the  chevalier  Ulric  de  Hut- 
ten,  after  having  been  in  some  sort  saturated  with  mercury,  found  him- 
self in  a  deplorable  condition ;  he  employed  this  decoction,  and  recovered 
his  health,  against  all  hope.  Pull  of  joy  and  gratitude,  he  wrote  a 
book,  to  recount  the  marvels  of  this  sovereign  specific.  Fracastor 
devoted  to  its  eulogy  the  major  part  of  the  third  volume  of  his  poem  on 
syphilis,  published  in  1530.  Practitioners  of  the  first  order  recom- 
mended it,  such  as  Nicholas  Massa,  who  was  also  a  skillful  anatomist, 
and  Musa  Brasavolo,  who  was  decorated  with  the  title  of  archiater,  by 


*Guy  de  Chauliac  gives  the  formula  of   an  ointment  into  which  mercury 
entered  for  a  tenth  part. 


432  REFORM   PERIOD. 

four  Popes,  and  with  that  of  consulting  physician  by  Charles  V.,  Francis 
I.,  and  Henry  VIII.,  king  of  England.  Divine  Providence  was  praised 
for  having  created  this  precious  tree  in  the  country  even,  which  was 
regarded  as  the  cradle  of  the  venereal  pest,  placing  thus  the  remedy,  as 
was  said,  by  the  side  of  the  evil.  Shortly  after,  sarsaparilla  and  china- 
root  shared  the  antisyphilitic  reputation  of  the  guaiacum. 

But  after  a  half  century,  the  renown  of  these  exotic  vegetables  fell 
considerably.  The  cures  effected  by  their  means,  became  mo?e  and 
more  rare,  and  finally  it  was  ascertained  that  alone,  they  had  but  little 
efficacy,  and  that  in  our  climates  they  only  succeeded  when  used  with, 
or  after,  mercurial  preparations.  The  chemical  physicians  had  never 
discontinued  their  employment  of  the  latter,  but  they  studied  to  mask 
them,  and  prevent  dangerous  results,  by  all  sorts  of  combinations.  A 
prejudice,  which  was  derived  from  the  reigning  theories,  opposed  the 
perfection  of  treatment  by  mercury.  The  prevailing  opinion  was,  that 
the  venereal  virus  should  be  expelled  either  by  sweats  or  salivation,  or 
by  some  other  emunctory,  and  in  no  other  way  was  it  supposed  that  a 
radical  cure  could  be  obtained.  Eichard  Wiseman,  surnamed  the  Pare 
of  England,  signalized,  among  the  number  of  mercurial  preparations 
used  in  1G76,  corrosive  sublimate,  dissolved  in  water,  and  taken  inter- 
nally, in  a  dose  sufficient  to  excite  vomiting,  or  produce  salivation. 

Nicholas  Pechlin,  and  Erancis  Chicoyneau,  were  the  first  who  stood 
up  against  this  prejudice,  at  the  beginning  of  the  seventeenth  century. 
This  idea  became  the  signal  of  a  great  progress.  In  1750  Van  Swieten, 
disciple  of  H.  Boerhaave,  and  physician  to  the  queen  of  Hungary,  directed 
all  physicians  of  the  military  and  civil  hospitals  of  the  Austrian  empire, 
to  treat  syphilis  after  a  uniform  method,  whose  efficacy  and  harmless- 
ness  a  long  experience  had  revealed  to  him.  It  consisted  principally  in 
prescribing  each  day  about  a  third  of  a  grain  of  corrosive  sublimate, 
dissolved  in  six  ounces  of  some  vehicle.  All  the  reports  were  favorable 
to  this  plan,  and  the  public  eulogies  bestowed  upon  it,  encouraged  very 
many  practitioners  to  adopt  the  use  of  the  liquor  of  Van  Swieten. 
Priugle  introduced  it  into  the  military  hospitals  of  Great  Britain,  and 
the  English  army-surgeons  gave  good  accounts  of  it. 

As  may  be  supposed,  the  formula  and  the  doses  prescribed  by  Van 
Swieten  were  modified,  in  certain  circumstances,  to  satisfy  particular 
indications.  Mercury  still  continued  to  be  associated  with  the  sudor- 
ifics,  sometimes  with  opium.  It  was  given  in  pills,  solution,  friction,  etc. 
Thus,  at  the  date  of  this  epoch,  the  Healing  Art  could  boast  of  possess- 
ing, against  the  great  generality  of  venereal  accidents,  an  almost 
infallible  specific,  which,  handled  with  circumspection,  is  never,  or  very 
rarely,  followed  with  bad  results. 


INTERNAL  THERAPEUTICS.  4E3 

TREATMENT   OP   PEHIODICAL   DISEASES. 

Under  this  denomiuation  Ave  now  comprise  a  multitude  of  diseases 
extremely  common  aud  varied.  They  constitute  two  very  distinct 
genera,  accordingly  as  they  present  themselves  under  the  form  of 
pyrexia,  or  apyrexia.  The  first,  which  are  the  most  common  and  the 
gravest,  have  been  known  from  all  antiquity.  They  arc  described  by 
ancient  authors  under  the  title  of  intermittent  and  remittent  fevers. 
The  second,  that  is  to  say,  the  periodical  affections  without  fever,  have 
only  been  observed  since  the  middle  of  the  eighteenth  century — the 
time  when  Casimir  JMedicus  first  assimilated  them  to  intermittent 
pyrexia.  The  ancients  did  not  know  any  specific  treatment  against 
periodicity.  The  following  is  what  Hippocrates  prescribed  in  inter- 
mittent fevers  of  various  types:  "When  any  one  is  tormented  with 
bile,  he  has  every  day  a  fever,  which  arises  at  midday,  and  then  ceases. 
In  this  state  a  purgative  should  be  given,  on  the  ninth  day.  If  the 
patient  has  no  evacuation  by  the  mouth,  he  should  be  purged  ;  but  if 
he  is  feeble,  injections  of  water  should  be  employed,  only.  When  the 
fever  permits,  a  hydromel  should  be  administered  in  the  morning,  before 
the  purgatives.  Pure  water  should  be  given  the  following  days,  and  as 
much  as  the  patient  wishes  to  take,  during  the  whole  duration  of  the 
fever.  As  soon  as  the  fever  appears  to  be  over,  a  tisane  with  cream,  a 
a  little  milk,  followed  by  good  wine,  diluted  with  water. 

2.  In  the  tertian  fevers,  a  purgative  should  be  given  after  the  fourth 
paroxysm.  When  it  is  thought  best  not  to  purge,  give  about  two 
ounces  of  the  juice  of  the  quintifolium,  in  water ;  if  this  is  not  bene- 
ficial, a  bath  should  be  given,  and  immediately  the  juice  of  the  syl- 
phium  {ferula  tingataiia,  Lin.),  with  clover,  in  equal  parts  of  wine 
and  water.  The  patient  should  be  kept  well  covered  in  bed,  to  produce 
perspiration.  During  the  perspiration,  if  he  thirsts  he  is  to  drink 
water  whitened  with  flour.  In  the  evening  he  should  take  a  little  millet 
cream  with  some  wine  in  addition.  He  must  use  sound  food  until  he  is 
cured. 

3.  In  the  quartan  fever,  the  purgation  must  begin  at  the  head,  after- 
ward through  the  bowels.  During  the  two  days  of  intermission,  a  bath 
is  to  be  given,  and  the  patient  must  drink  wine,  in  which  some  grains 
of  henbane  and  mandragora  have  been  infused,  with  a  drachm  of  the 
juice  of  sylphium  and  of  clover.  When  the  stomach  is  full,  an  emetic 
is  to  be  given.  After  the  following  paroxysm,  in  coming  from  the  hot 
bath,  he  must  be  kept  covered  until  the  perspiration  begins,  when  he 
must  take  a  second  vomit.  If  the  fever  does  not  cease,  the  head  must 
be  purged  again,  and  the  patient  be  placed  upon  the  use  of  emollient 


434  REFORM   PERIOD. 

and  bitter  aliments,  and  continue  to  take  the  hot  baths  in  the  days  of 
intermission. =•■' 

No  notable  amelioration  was  introduced  in  the  treatment  of  inter- 
mittent fevers,  from  Hippocrates  till  toward  the  middle  of  the  seven- 
teenth century  of  the  Christian  era.  Those  which  were  of  a  benign 
nature  and  reigned  sporadically,  were  cured  well  enough  after  a  longer 
or  shorter  period ;  but  those  which  were  developed  under  the  influence 
of  a  pernicious  epidemic  constitution,  prevailed  with  murderous  fury, 
carrying  off  the  patients  in  the  third  or  fourth  paroxysm.  A  good 
number  even  of  these,  which  were  not  of  a  malignant  nature,  after 
having  resisted  all  remedies,  degenerated  into  visceral  obstructions, 
hydropsies  and  phthisis,  which  conducted  the  patient  by  slow  degrees 
to  the  tomb. 

In  1638,  the  Countess  of  Cinchon,  the  wife  of  the  Vice-king  of 
Peru,  was  a  prey  to  a  fever  from  which  nothing  would  deliver  her.  A 
Spaniard,  some  say  that  it  was  the  Governor  of  Loxa,  having  learned 
from  the  natives  of  the  country  the  secret  of  the  febrifuge  qualities  of 
the  cinchona,  advised  the  countess  to  employ  it.  She,  after  much  hesi- 
tation, resolved  to  try  it,  and  recovered  her  health  as  by  enchantment. 
Such  is,  according  to  the  most  accredited  opinions,  the  origin  of  the  great 
reputation  of  this  bark ;  nevertheless,  M.  A.  de  Humbolt  discredits  a 
part  of  the  story.  He  asserts  that  the  aborigines  of  the  nei.<7hborhood 
of  Loxa,  as  well  as  other  provinces  of  South  America,  where  intermit- 
tent fevers  are  very  common,  far  from  suspecting  the  febrifuge  virtue 
of  the  bark,  often  prefer  to  die  rather  than  make  use  of  it.  They  be- 
lieved, formerly,  even,  that  the  Europeans  sought  this  substance  with  so 
much  earnestness  only  as  dye  stuif.  Humbolt  infers  from  this,  that  it 
is  not  very  probable  that  the  Indians  furnished  to  the  Spaniards  the 
first  indications  of  the  medical  properties  of  cinchona.  However  this 
may  be,  it  is  not  questionable  that  in  1639,  the  Countess  of  Cinchon 
and  her  physician,  Juan  Lopez  de  Vega,  imported  into  Spain  a  certain 
quantity  of  this  bark,  reduced  to  powder,  and  distributed  it  to  various 
persons.  But  it  was  not  made  an  article  of  commerce  till  ten  years 
later,  by  the  Jesuits  of  Eome,  who  had  received  a  considerable  mass  of 
it.  It  was  retailed  in  Spain  as  the  "  Countess'  Powder,"  and  in  Italy 
as  the  "Jesuits',  or  Cardinal's  Powder."  As  it  was  very  dear,  it  was  soon 
adulterated  in  so  many  ways  as  to  make  it  very  difficult  in  the  end  to 
procure  it  of  pure  and  good  quality. 

Accident  thus  had  placed  in  the  possession  of  Medicine  a  precious 
remedy ;  but  there  remained  an  immense  task  for  science  to  fullfil.     It 

^  Hippocrates,  Treatise  oxi  Disease. 


INTERNAL  THERAPEUTICS.  435 

was  necessary :  First,  to  determine  tlie  botanical  characters  of  the  plant 
which  furnished  it,  in  order  that  it  might  be  recognised  wherever  found; 
Second,  to  ascertain  the  chemical  elements  of  good  cinchona,  in  order  to 
uncover  the  sophistications  of  which  it  was  the  subject,  and  to  separate, 
if  possible,  its  activ^e  principle  from  the  other  elements ;  Third,  and  lastly, 
to  establish  its  curative  properties,  to  fix  the  curative  indications  it 
should  fullfil,  the  most  advantageous  modes  of  administration,  suitable 
doses,  etc. 

La  Condamine  was  the  first  who  gave  a  description  sufficiently  com- 
plete, of  the  tree  which  produces  the  cinchona.  This  illustrious  geome- 
trician having  been  sent  to  America  to  measure  several  degrees  of  the 
meridian  of  Quito,  found  himself  placed,  from  the  nature  of  his  opera- 
tions, in  the  regions  where  these  trees  grow.  He  described  several 
species  of  them,  furnished  precise  instructions  concerning  the  qualities 
of  the  barks,  the  size  and  thickness  of  the  trees,  the  places  where  they 
are  found,  etc.  His  work,  which  was  printed  in  the  memoirs  of  the 
"Academy  of  Sciences,"  in  the  year  1738,  served  as  a  guide  for  Linnseus, 
to  trace  the  characters  of  the  genus,  to  which  he  gave  the  name  of  cin- 
chona, in  memory  of  the  lady  who  first  introduced  the  plant  into  Europe. 

Many  other  naturalists  endeavored  to  complete  the  natural  history  of 
the  genus  cinchona.  They  discovered  a  great  number  of  new  species, 
which  they  found  north  and  south  of  the  equator,  and  in  very  different 
latitudes.  Among  these,  I  will  cite  first,  Celestino  Mutis,  to  whom  we 
owe  the  description  of  the  britannic  riches  of  Xew  Grenada,  and  espe- 
cially of  several  species  of  cinchona,  unknown  till  then ;  Euiz  and  Pavon, 
authors  of  the  flora  of  Chili  and  Peru ;  MM.  do  Humboldt  and  Bonpland, 
whose  travels  in  the  equinoxial  regions  have  thrown  so  much  light  on  all 
the  departments  of  the  physical  sciences  and  natural  history. 

A  great  number  of  chemists  have  attempted  to  penetrate  the  intimate 
constitution  of  cinchona.-'  Poullctier  de  la  Salle  made  the  first  important 
remark  on  the  alcoholic  extract  of  the  substance.  Instead  of  consider- 
ing it,  according  to  the  common  opinion  of  his  times,  as  a  resine,  he 
observed  that  water  dissolved  it ;  and  he  called  it  resiniform  matter, 
because  its  resinous  characters  appeared  to  him  more  marked  than  the 
gummy  ones.  I  will  cite,  also,  because  it  has  shed  some  light  on  the 
intimate  constitution  of  the  bark  of  Peru,  the  analysis  of  Buquct  and 
Cornette,  charged  by  the  Eoyal  Society  of  Medicine,  of  France,  in  1779, 
to  examine  two  specimens  sent  from  Santa  Fe  de  Bogota  ;  that  of  Four- 
croy  in  1791 ;  and  that  of  Doctor  Westring,  consigned  in  the  memoirs  of 

*■  Merat  et  Delens,  Dictionnaire  Universal  of  Materia  Medica  and  Therapeutics. 
Paris,  18.33. 


-436  REFORM    PERIOD. 

the  Academy  of  Stockholm  for  1800-1801.  He  directed  his  researches 
toward  an  end  eminently  useful;  he  proposed  to  determine,  among  the 
constituent  principles  of  cinchona,  the  one  to  which  its  curative  virtues 
belonged.  If  he  had  not  the  glory  to  attain  an  end  so  desirable,  he  had, 
at  least,  the  merit  of  indicating  it.  Later,  we  shall  see  the  labors  of 
two  French  chemists  crowned,  in  this  respect,  with  complete  success. 

Nevertheless,  the  most  important  and  most  difficult  questions  to  solve,  on 
the  subject  of  the  new  medicament,  did  not  lie  within  the  reach  of  either 
botany  or  chemistry,  but  rather  of  practical  medicine.  It  is  the  latter 
which  had  to  pronounce  definitely  upon  the  value  of  the  curative  proper- 
ties attributed  to  the  substance,  on  the  modes  of  its  administration  and 
proper  doses,  and  on  the  pathological  circumstances  which  may  indicate 
or  centra-indicate  its  employment. 

The  first  one  who  wrote  on  the  medicinal  virtues  of  cinchona,  was  a 
Spanish  physician  named  Barba.  He  demonstrated  the  efficacy  of  this 
powder  in  a  tertian  fever,  and  replies  to  the  objections  of  some  physi- 
cians of  his  country,  who  condemned  its  use.  His  book  was  printed  at 
Seville,  in  16-12.  Morton  speaks  of  a  short  treatise  drawn  up  in  1651, 
by  the  physicians  of  Eome,  which  fixed  the  dose  of  the  powder  at  two 
drachms,  and  recommended  the  employment  of  laxatives  before  adminis- 
tering it.  They  advised,  after  its  administration,  to  await,  tranquilly, 
the  sweats  it  usually  provoked,  before  recurring  to  any  other  remedy. 

About  the  same  time,  cinchona  was  introduced  into  England,  but  it 
soon  fell  into  contempt,  owing  to  the  ignorance  of  the  true  manner  of 
administering  it.  Several  patients  perished  from  its  improper  use — 
among  others  Senator  Underwood  and  Captain  Potter — which  disgusted 
many  physicians  with  its  use,  but  instigated  others,  especially  the  sage 
Sydenham,  to  seek  a  better  method  for  its  administration. 

A  charlatan  named  Talbot,  or  Talbor,  profited  by  the  discredit  into 
which  this  substance  had  fallen,  to  administer  it  as  a  secret  remedy. 
After  having  astonished  London  by  his  numerous  cures,  and  amassed  a 
fine  fortune,  he  went  to  Paris,  where  he  obtained  no  less  brilliant  success; 
among  others,  he  cured  the  Dauphin  of  an  intermittant  fever,  which  the 
court  physicians  had  not  been  able  to  cure.  The  king  bought  his  secret 
for  the  sum  of  two  thousand  louis  d'or,  and  a  pension  during  life  of  two 
thousand  francs.  After  the  death  of  Talbot,  the  French  Government 
published  his  recipe,  the  principal  ingredient  of  which  was  nothing  but 
cinchona,  disguised  by  the  addition  of  other  substances. 

At  the  head  of  those  persons  who  contributed  to  propagate  the  methodic 
employment  of  the  Peruvian  bark,  I  must  name  Sebastian  Badio,  or 
Baldies,  whose  dissertation,  published  in  16G3,  had  especially  for  its 
aim  to  refute  the  attacks  of  Chifflet  and  Plempius  against  this  remedy ; 


INTERNAL  THERAPEUTICS.  437 

Eichard  Morton,  a  celebrated  practitioner  of  London,  wliose  Pyretology, 
published  in  1692,  had,  for  a  long  time,  a  distinguished  reputation  ;  and, 
above  all  the  preceeding,  Francis  Torti,  professor  of  medicine  at  the 
Grymnasium  of  Modena,  and  author  of  a  classic  treatise  on  pernicious 
fevers.  •■'  No  one  had  before  demonstrated  with  so  much  force  and  reason, 
the  superiority  of  cinchona  over  all  other  remedies,  in  that  class  of  dis- 
eases, and  no  one  had  refuted  in  so  victorious  a  manner,  the  objections 
of  its  adversaries.  He  wrote  at  the  beginning  of  the  eighteenth  century, 
from  which  period  we  may  regard  the  cause  of  cinchona  as  gained. 
After  him,  Werlhof  published  new  observations,  which  fully  confirmed 
those  of  the  professor  of  Modena.  He  demonstrated  the  futility  of  the 
arguments  founded  on  theories,  and  demanded  only  the  proofs  of  expe- 
rience. His  writings  are  a  model  of  urbanity,  elegance,  and  sound  eru- 
dition. After  having  proved  how  vain  were  the  high  controversies  on 
the  essence  and  proximate  causes  of  fevers,  he  recounts,  among  others, 
the  following  anecdote  :  "  The  empiric  Talbot  was  one  day  called  to  a 
patient  attacked  with  a  chronic  fever.  His  physician,  who  had  been  in 
attendance  a  long  time  without  effecting  anything,  consented  to  admit 
Talbot  to  consultation,  with  very  great  repugnance.  As  soon  as  they 
were  assempled,  the  dean  of  the  consultation  gravely  asked  Talbot  this 
question:  '  What  is  a  fever?'  'A  fever,'  responded  the  latter,  very 
reverently,  '  is  something  which  I  cannot  define,  but  which  I  can  cure ; 
while  you,  perhaps,  may  be  able  to  define,  but  cannot  cure  it.'  "  f 

In  the  second  half  of  the  eighteenth  century,  Casimir  Medicus  assimi- 
lated, under  certain  aspects,  periodical  affections  without  fever  to  inter- 
mittent pyrexias,  and  applied  the  same  treatment  to  them  vrith  great 
success.  This  happy  employment  of  cinchona  against  a  new  order  of 
diseases,  added  very  much  to  the  importance,  already  very  great,  of  this 
exotic  medicament. 

TREATMENT   OF   OTHER,    DIVERSE   DISEASES. 

We  have  mentioned  the  prophylactic  treatment  of  variola,  in  the 
chapter  on  Hygiene,  and  endeavored  to  appreciate  the  extent  of  the 
services  rendered  to  humanity  by  the  practice  of  inoculation,  and  above 
all,  by  the  discovery  of  vaccination,  which  we  shall  not  dwell  upon 
again.  But,  besides  these  capital  ameliorations,  several  others,  less 
striking,  which  have  also  their  utility,  were  introduced  into  the  treat- 
ment of  several  diseases.  Therapeutics  essayed  to  appropriate  to  its 
use  a  quantity  of  new  substances  but  little  known  to  the  ancients ;  such 

"  Therapcutice  specialis  ad  febres  periodicas  perniciosas,  Mutina;,  1712.     Nova 
editio  curantibus  Tombeur  et  Brixlie,  Leodi,  1821. 
t  Werlhof,  Observations  de  febribus. 


438  ERUDITE   PERIOD. 

as  the  different  gases,  electricity,  galvanism,  tartar  emetic,  proscribed 
by  a  decree  of  the  parliament  of  Paris,'-''  ipecacuanha,  belladonna, 
digitalis,  etc. 

In  short,  the  period  through  which  we  have  just  passed  has  effected 
in  therapeutics  ever  memorable  improvements :  the  ravages  of  variola, 
so  to  say,  annihilated  in  its  source ;  those  of  intermittent  fevers,  and 
periodical  affections  in  general,  arrested  at  their  beginning ;  the  repul- 
sive contamination  of  syphilis,  which  menaced  the  human  species  with  a 
progressive  degradation  by  its  hereditary  transmissibility,  unmasked  and 
vanquished  in  the  most  of  its  metamorphoses ;  in  fine,  a  multitude  of 
secondary  ameliorations  introduced  into  the  treatment  of  many  other 
diseases,  without  counting  the  improvements  so  remarkable  in  surgery 
and  obstetrics,  of  which  account  will  be  taken  hereafter :  behold,  un- 
questionably, imperishable  titles  to  the  gratitude  of  all  generations  ;  and 
if  the  modern  tables  of  mortality  do  not  lead  us  into  error,  if  the  exten- 
sion of  the  mean  duration  of  life,  established  by  them,  is  a  reality,  as  we 
are  all  led  to  believe,  what  science  can  claim,  in  this  happy  result,  a  part 
equal  to  that  of  medicine  ? 

An  important  remark  on  the  subject  of  all  these  beautiful  improve- 
ments remains  still  to  be  made,  which  is,  that  they  were  all  accomplished, 
not  in  virtue  of  prevailing  theories,  but  in  spite  of  them ;  that  the  great- 
est obstacles  they  had  to  surmount,  to  become  established,  came  from  these 
very  theories.  If  mercurial  medication  was  continued,  so  as  to  excite 
salivation,  or  to  the  production  of  those  injurious  effects  which  made  it 
formidable,  it  was  in  perfect  harmony  with  the  Galenic  theory,  according 
to  which  it  was  not  doubted  but  that  the  syphilitic  virus  circulated 
with  the  humors  of  the  body ;  whence  it  followed,  that  it  was  necessary 
to  provoke  some  evacuation  or  other  to  expel  this  virus.  What  was  the 
reproach  that  the  adversaries  of  cinchona  brought  against  that  medica- 
ment? It  was,  that  it  produced  no  sensible  evacuation.  Now,  in  their 
opinion,  founded  on  the  authority  of  Hippocrates,  Galen,  and  others,  the 
proximate  cause  of  intermittent  fevers  could  be  nothing  else  than  vitiated 
bile  or  phlegm ;  so  that  a  medicament  which  expelled  neither  the  bile 
nor  the  phlegm,  could  not,  according  to  their  doctrine,  radically  cure  an 
attack  of  fever.  The  Stahlites  made  a  more  specious  objection  still,  to 
the  employment  of  cinchona ;  they  said  that  fever  is  a  natural  and  salu- 
tary effort  of  the  soul,  to  free  itself  from  an  injurious  substance,  and  that 
to  suspend  or  arrest  the  accession,  was  contrary  to  the  tendency  of  the 
vital  principle,  and  produced,  in  reality,  more  harm  than  good.  If 
vaccination   itself  has   encountered   opponents,   was   it  not   especially 

"See  Lettres  de  Gui  Patin,  with  Notes  by  Reveille  Parise;  Paris,  1816. 


EXTERlSrAL   PATHOLOGY   AND   THERAPEUTICS.  439 

because  tbe  Arabs,  who  first  described  variola,  bad  at  tbe  same  time  prop, 
agated  tbe  opinion  that  tbe  principle  of  tbis  disease  is  innate  in  man ; 
wbence  it  was  concluded,  that  to  prevent  its  spontaneous  development, 
was  to  oppose  tbe  proper  action  of  nature — to  keep  tbe  enemy  in  bis 
place  ? 

In  tbe  opinion  of  every  one,  tbe  progress  tbat  tberapeutics  made,  and 
wbicb  we  bave  just  pointed  out,  was  due  to  tbe  pure  experimental 
metbod,  i.  e.,  to  Empiricism  ;  not  to  tbat  blind  and  ignorant  empiricism 
of  cbarlatans,  and  medicasters,  and  pbarmacopolists,  wbo  content  tbem- 
selves  with  asking  tbe  name  of  a  disease,  and  witbout  otber  knowledge 
deliver,  witbout  hesitation,  tbeir  drugs,  but  to  tbe  enligbtened  and 
methodic  Empiricism  wbicb  calls  to  its  aid  all  the  positive  indications 
of  physiology,  pathology,  and  tbe  accessory  sciences — to  the  empiricism 
of  Sydenham,  Morton,  Torti,  Werlhof,  Berenger  de  Carpi,  Van  Swieteu, 
Lieutaud,  Stoll,  Jenner,  and  other  practitioners  of  such  merit ;  to  tbat 
Empiricism  for  which  Kurt  Sprengel  offers  apologies,  in  so  many 
instances,  and  notably,  in  chapter  second  and  third,  of  the  sixteenth 
section  of  bis  History  of  Medicine. 


CHAPTEK    VI. 

EXTERNAL  PATHOLOGY  AND  THERAPEUTICS. 

We  have  seen  that  surgery,  after  having  been  so  long  disdained  and 
oppressed  by  the  Clinical  physicians  of  tbe  middle  ages,  was  gradually 
elevated  from  this  abasement,  and  signalised  its  resurrection  in  Europe 
by  discoveries  and  improvements  of  tbe  highest  interest.  Tbe  sixteenth 
century  had  produced  some  surgical  reputation  out  of  line,  but  the 
first  half  of  the  seventeenth  was  less  fruitful  in  illustrations  of  this 
kind.  During  tbis  lapse  of  time,  Severin  Pinau  and  John  Bienaise  are 
nearly  the  sole  representatives  of  French  surgery ;  Marcus  Aurclius 
Severino  and  Peter  de  IMarchetti  sustained  still,  somewhat,  the  glory  of 
the  Italian  school,  which  declined,  after  them,  to  flourish  again  only 
toward  the  close  of  tbe  eighteenth  century ;  German}^  saw  arise  no 
worthy  successor  of  Fabricius  de  Hilden ;  in  Switzerland,  no  one  replaced 
Felix  Wurz  ;  Holland  possessed  only  John  Van  Horn  ;  and  England, 
until  then  one  of  tbe  countries  most  in  arrears,  in  tbe  progress  of  sur- 
gery, gave  birth  to  a  man  who  revived,  and  was  tbe  dawn  in  her,  of  the 
genius  of  surgery.  Pdchard  AViseman  was  the  A.  Pare  of  the  Brittanic 
nation  ;  his  collection  of  treatises  has  always  preserved  its  interest,  as 
one  of  the  most  precious  monuments  of  English  surgery. 


440  REFORM   PERIOD. 

Toward  tlie  close  of  the  seventeenth  century,  and  during  the  whole 
course  of  the  eighteenth,  this  branch  of  the  Healing  Art  emerged  anew 
from  its  state  of  stagnation,  and  took  a  development,  of  which  no  other 
period  in  its  history  offers  us  an  example.  Among  the  causes  which 
contributed,  in  France,  to  give  it  a  strong  impulse,  we  shall  cite,  in  the 
first  place,  the  creation  of  five  chairs  of  demonstrators  of  anatomy  and 
surgery,  instituted  in  the  college  of  Saint  Come,  by  letters  patent,  in 
September,  1724.  G-.  Mareschal,  first  surgeon  of  Louis  XV.,  and 
La  Peyronie,  his  friend  and  colleague,  who  was  destined  to  be  his  suc- 
cessor, were  the  first  instigators  of  that  measure.  La  Peyronie  com- 
pleted it,  in  adding  to  the  five  royal  demonstrators,  a  sixth,  for  the 
course  on  accouchements,  and  six  adjuncts,  whose  salaries  he  paid  him- 
self. This  enlightened  philanthropist  did  not  limit  his  benefits  to  the 
capital ;  he  obtained  for  Montpellier  the  nomination  of  four  professors 
and  four  adjuncts,  who  wcx'e  rerjuired  to  include  in  their  lectures  all 
branches  of  surgery.  But  he  lacked  an  amphitheater,  and  no  emolu- 
ments were  attached  to  the  chairs  which  were  just  created.  La  Peyronie 
removed  all  these  difficulties,  and  provided  everything  from  his  own 
purse.  In  fine,  he  secured  the  future  of  these  institutions,  by  leaving 
in  his  will  provisions  for  their  support. 

It  is  to  him,  also,  and  to  Mareschal,  that  France  was  indebted  for 
another  endowment,  which  exercised,  during  more  than  half  a  century, 
a  powerful  influence  on  the  progress  of  surgical  studies  in  Europe. 
The  Eoyal  Academy  of  Surgery,  instituted  in  1731,  became,  from  its 
origin,  a  focus  toward  which  converged  the  labors  of  a  crowd  of  surgeons 
of  France  and  foreign  nations.  It  received,  among  others,  communica- 
tions from  John  Louis  Petit,  Ledran,  Garengeot,  Lafaye,  Csesar  Verdier, 
S.  Morand,  Quesnay,  Hevin,  Fabre,  Lecat,  Puzos,  Bordenave,  Sabatier. 
and  above  all  from  A.  Louis.  To  the  Royal  Academy  of  Surger}^  we 
must  attach  the  names  of  Lamotte,  Eavaton,  Friar  Come,  Master  John, 
Anthony  Petit,  Poutcau,  etc.,  who  shared  its  fame,  and  enriched  science 
by  their  writings.  Then  succeeded,  in  the  history  of  this  Art,  the  School 
of  Practical  Surgery,  {Ecole  Pratique  de  Ghirurgie)  established  by  a 
decree  of  council,  in  1750.  It  was  here  that  Chopart  taught  with  so 
much  zeal,  and  where  his  intimate  friend,  P.  J.  Dcsault,  commenced,  as 
clinical  professor.  That  clinic,  the  first  which  France  offered  as  a 
model,  soon  acquired  a  European  renown,  and,  to  such  a  hight,  that 
neighboring  nations  sent  to  Paris  pensioned  students,  to  follow  the 
course  of  Desault.  From  this  school  came  forth  Anthony  Dubois,  A. 
Boyer,  and  so  many  others  that  the  enumeration  would  be  too  long. 

While,  by  a  happy  concourse  of  circumstances,  French  surgery  shone 
thus,  in  the  first  rank,  the  neighboring  nations  advanced  in  the  same 


EXTEKNAL   PATHOLOGY  AND  THERAPEUTICS.  441 

career  with  a  praisewortliy  emulation.  England  could  enumerate  with 
pride  Cheselden,  Douglas,  the  two  Monros,  Sharp,  Cowper,  Pott,  B.  Bell, 
J.  Hunter,  etc.;  Italy  had  her  Molinelli,  Bertrandi,  Guattani,  Moscati, 
Scarpa ;  Holland  possessed  Deventer,  and  P.  Camper ;  Germany,  and 
the  countries  farther  north,  saw  flourish  L.  Heister,  John  Zacharia 
Platner,  Stein,  Eoederer,  Brambilla,  Acrel,  Callisen,  Theden,  Augustus 
Kichter,  etc. 

From  the  concourse  of  all  these  celebrated  men,  and  a  great  number 
of  others,  external  pathology  and  therapeutics  were  elevated  to  an 
unheard  of  degree  of  perfection.  Surgery  showed  itself  worthy  to  march 
the  peer  of  Medicine,  and  the  inseparable  union  of  those  two  twin- 
sisters,  was  sanctioned  in  France,  at  the  time  of  the  restoration  of  its 
Medical  schools,  in  1795.  To  give  an  idea  of  the  numerous  ameliora- 
tions accomplished  in  external  pathology  and  therapeutics,  during  the 
Eeform  Period,  we  will  take  a  rapid  glance  over  the  history  of  some 
of  the  principal  Surgical  operations. 

■WOUNDS    OP   THE   HEAD. 

Among  the  operations  to  which  the  wounds  of  the  superior  part  of 
the  body  may  give  rise,  one  of  the  gravest  and  most  delicate,  is,  beyond 
contradiction,  that  of  trephining,  which  is  often  alluded  to  in  the 
Hippocratic  works.  The  manner  of  executing  it ;  the  cases  where 
it  is  indicated ;  the  dangers  to  which  it  exposes  the  patient ;  the  pre- 
cautions that  it  requires,  are  all  traced  with  a  correctness  which 
proves,  that,  for  a  long  time,  the  Asclepiadge  had  been  in  the  habit  of 
practicing  it. 

The  Surgeons  of  the  Alexandrian  school,  notwithstanding  the  supe- 
riority of  their  anatomical  knowledge,  added  very  little  to  the  precepts 
of  the  Hippocratists,  concerning  this  operation.  Celsus  furnishes  only 
a  few  details  on  the  modes  of  operation  and  on  the  form  of  the  instru- 
ments.'"' The  Greek  and  Latin  physicians  of  the  following  ages 
abandoned  the  great  operations,  and  limited  themselves  in  the  treat- 
ment of  the  wounds  of  the  head,  to  the  use  of  ointments,  cataplasms  and 
other  extsrnal  applications,  which  they  decorated  with  the  title  of 
vulnerary.  Among  the  Arabs,  Albucasis  alone,  seems  to  have  employed 
the  trephine.  Among  the  clergy  who  monopolized  the  Healing  Art 
during  the  middle  ages,  Guy  de  Chauliac  was  the  first,  to  draw  from 
oblivion  this  instrument,  and  the  operation  it  recalls.  From  that 
period  trephining  never  fell  into  disuse  again.  The  forms  of  the 
instruments  employed  by  the  ancients  were  modified  in  various  ways, 

~  Liv.  viii,  chap,  iii,  editioa  of  Ameloveen,  Amsterdam,  1713. 

28 


442  REFOKM   PERIOD. 

but  efforts  were  especially  made  to  establish  the  indications  with  exact- 
ness ;  but,  in  short,  no  capital  improvement  was  introduced  by  moderns 
into  this  branch  of  Surgery. 

DISEASES  OP  THE  EYE. 

Cataract. — The  ancients  had  only  very  confused  ideas  on  the  nature 
and  seat  of  this  affection.  Celsus,  who  was  the  first  to  speak  of  it,  says : 
"  Often  as  the  result  of  a  blow  or  a  disease,  the  humor  contained  in  the 
empty  space  which  I  have  said  exists  behind  the  two  tunics  ( the 
transparent  cornea  and  the  iris )  becomes  concrete,  gradually  hardens, 
and  obstructs  the  sight;  there  results  from  it  an  infirmity  which  is 
sometimes  curable  and  sometimes  not.=-'  Then  the  Eoman  encyclopedist 
enumerates  the  cases  in  which  an  operation  may  be  attempted  with 
some  hope  of  success,  and  those  in  which  it  appears  formally  con- 
tra-indicated. These  last  are,  according  to  him,  much  the  most 
numerous. 

As  to  the  mode  of  operating,  he  describes  only  the  one  that  is  known 
as  the  method  of  couching.  However,  he  does  not  doubt  but  that  the 
method  by  extraction  was  known  to  the  ancient  Greeks.  Ehazes,  who 
gives  a  detailed  description  of  it,  assures  us  that  it  was  practiced  by 
Antyllus,  a  celebrated  surgeon,  who  lived  at  the  commencement  of  the 
second  century  of  the  Christian  era.f 

"  Paul  of  ^gina,  and  Albucasis,  followed  the  method  of  Celsus  ;  the 
ecclesiastical  physicians  of  the  middle  ages  knew  no  other;  and  those  of 
the  Erudite  Period  did  not  show  themselves  any  more  bold,  notwith- 
standing the  progress  of  anatomy.  During  all  this  period  of  time,  the 
method  by  extraction  was  completely  abandoned  by  instructed  surgeons. 
A  few  intinerant  operators  only,  dared  practice  it ;  but  the  men  of 
the  Art  rejected  it  because  it  occasioned  the  loss  of  the  humors  con- 
tained in  the  chambers  of  the  eye,  an  occurrence  which  they  believed 
very  formidable. 

It  was  onl}'  towards  the  close  of  the  seventeenth  century,  that  sounder 
ideas  on  the  nature  and  seat  of  cataract  began  to  prevail.  It  was  then 
ascertained  that  it  did  not  proceed  from  a  condensed  humor,  as  had  been 
taught  by  Celsus,  nor  from  a  thin  pellicle  si)read  before  the  pupil,  as 
had  been  believed  in  the  middle  ages;  but  that  it  consisted  in  the 
opacity  of  the  crystalline  lens,  or  its  capsule.  This  was  a  great  step 
towards  the  rational  ti-eatment  of  this  disease.  From  that  time  two 
species  were  distinguished,  namely,  the  crystalline  and  the  capsular; 
and  the  signs  were  established  to  determine  each  of  them.    The  certainty 

"  Loc.  Cit.  t  Continens,  lib.  iii.,  chap.  iii. 


EXTERNAL   PATHOLOGY  AND  THERAPEUTICS.  443 

of  tlie  renewal  of  the  humor  of  the  chambers  of  the  eye  was  also 
ascertained,  which  removed  all  apprehension  about  any  injury  from  its 
discharge.  Consequently  they  established  much  better  than  ever  had 
been  done  before,  the  indications  which  should  determine  the  surgeon  to 
prefer,  in  certain  cases,  such  or  such  a  mode  of  operation. 

On  Fistula  Lachrymalis. — It  is  also  in  the  work  of  Celsus,  that  we 
find  the  first  mention  of  this  disease,  which  the  Greeks  named  cegilops. 
The  ulcer,  he  says,  sometimes  attacks  the  os  unguis  and  penetrates 
to  the  nostrils.  When  it  assumes  a  carcinomatous  form,  it  would  be 
not  only  useless,  but  also  dangerous  to  touch  it.  If  on  the  contrary 
the  disease  is  recent,  and  is  not  too  extensive,  a  cure  may  be  hoped 
for.  To  efi"ect  this,  the  superior  part  of  the  ulcer  should  be  seized 
with  a  crotchet,  and  incised  to  the  bone.  Then  the  osseous  canal 
should  be  penetrated  with  a  red  hot  iron,  care  having  been  taken  pre- 
viously, to  protect  the  eye  and  surrounding  parts,  so  as  to  guarantee 
them  from  the  contact  of  the  heat.  Some  prefer  the  use  of  caustics, 
as  the  green  or  blue  cojiperas,  but  these  remedies  act  slowly,  and  in  a 
variable  manner. =-= 

To  this  method  the  Arabs  added  three  others,  namely,  compression, 
injections,  and  tents.  Ehazes  was  the  first  to  remark,  that  a  continued 
pressure,  seconded  by  frictions,  sufiices  to  cure  certain  fistulce  lachry- 
malia.  He  speaks  also  of  injections  that  may  be  used  through  cannulse. 
Avicenna  counsels  the  introduction  into  the  nasal  canals,  of  a  thread 
saturated  with  depuratives,  which  must  be  withdrawn  every  day,  until 
the  passage  be  entirely  free.  We  see  by  this  the  Arabs  knew  nearly  all 
the  methods  in  use  among  moderns,  in  this  disease. 

The  Latins  of  the  middle  ages  employed  only  escharotics  and  the 
actual  cautery.  Those  of  the  Erudite  Period  employed  exactly  the  same 
means ;  but  in  the  course  of  the  seventeenth,  and  especially  of  the 
eighteenth  centuries,  all  the  proceedures  known  to  the  Arabs  were  still 
honored,  and  considerably  perfected,  and  a  better  judgment  was  formed 
of  their  advantages  and  particular  inconveniences. 

On  the  Synizesis  or  Synechia. — The  pupil  is  susceptible  of  a 
morbid  constriction,  and  even  a  complete  obliteration,  which  con- 
stitutes the  affection  called  synizesis.  This  occlusion  is  rarely  con- 
genital;  however  it  may  be  in  the  newly  born,  resulting  from  the 
persistence  of  the  pupillary  membrane.  Such  individuals  are  born 
blind,  though  their  eyes  possess  otherwise  all  the  conditions  requisite 

*  Celsus,  lib.  -vii.  chap.  vii.  §  viii. 


444  REFORM   PERIOD. 

for  seeing.  Accidental  synizesis  is  much  more  common,  and  occurs 
from  varied  causes :  sometimes  it  arises  as  the  result  of  an  opera- 
tion for  cataract,  or  a  violent  inflammation  of  the  eye:  again,  it  has 
been  attributed  to  the  repercussion  of  any  morbid  vice,  such  as  that 
of  tetter,  gout,  etc.,  and  it  may  manifest  itself  without  any  apparent 
cause. 

The  ancients  did  not  attempt  the  treatment  of  this  infirmity,  and 
the  unfortunate  who  were  attacked  with  it,  went  the  rest  of  their  days 
deprived  of  sight.  In  1732,  William  Cheselden  published  the  history 
of  a  very  delicate  operation  for  its  relief,  which  he  had  successfully 
performed.  This  operation  consisted  in  making  an  opening  or  artificial 
pupil,  in  the  center  of  the  iris.  The  same  operation  was  repeated  several 
times  afterwards,  but  never  or  rarely  ever  succeeded ;  the  process  of 
Cheselden  was  therefore  judged  defective.  Other  surgeons  made  useful 
corrections  in  it,  by  means  of  which,  they  obtained  better  results. 
Thenceforth  the  operation  was  a  therapeutical  conquest,  and  took  rank 
among  the  discoveries  of  modern  surgery. 

DISEASES   OE   THE   NOSE. 

Nasal  Polypus — The  Hippocratic  works  mention  four  species  or  varie- 
ties of  this  disease,  and  they  indicate  a  curative  method  appropriate  to 
the  nature  of  the  excrescence  in  each  case.  If  the  polypus  is  soft  and 
adheres  by  a  small  peliclc,  it  was  advised  to  tear  it  loose  and  draw  it  forth. 
If  it  was  hard,  it  was  to  be  cauterised  with  the  actual  cautery.  If  it  was 
soft  and  adhered  by  a  large  pelicle,  a  ligature  was  used.  If  of  a  stony 
hardness  it  was  to  be  excised.  In  all  cases,  the  cure  was  terminated  by 
mild  caustics  and  emolients. 

The  Greeks  of  the  following  ages  added  very  little  to  these  precepts. 
The  Arabs  and  the  Latins  of  the  middle  ages  adhered  to  the  ligature 
and  caustics  only;  but  at  the  epoch  of  the  restoration  of  the  sciences  in 
Europe,  all  the  means  employed  in  antiquity,  were  restored  to  practice 
and  examined.  A  closer  study  of  the  effects  of  each  of  these  applica- 
tions was  carefully  made.  Gabriel  Fallopius  and  Andrew  Levret 
concurred,  especially  to  clear  the  diagnosis  and  treatment  of  this 
disease. 

Rhinoplasty — This  word  is  intended  to  designate  an  operation  which 
is  designed  to  reconstruct  the  entire,  or  a  considerable  part  of  the  nose. 
Peter  Eanzano,  Bishop  of  Lucern,  is  the  first  who  made  mention  of  it  in 
his  Annals  of  the  World.  According  to  the  report  of  this  historian,  there 
lived  in  Sicily,  in  1442,  a  family  of  the  name  of  Branca,  which  pos- 
sessed the  art  of  reconstructing  the  nose  and  other  parts  of  the  face, 
from  the  flesh  of  the  arm.     This  art  passed  from  Sicily  into  Calabria, 


» 


EXTERNAL   PATHOLOGY   AND   THERAPEUTICS.  445 

where  it  was  practiced  by  the  family  Via' co,  or  Bojano,  at  the  com- 
mencement of  the  sixteenth  century.  Alexander  Benedetti,  a  celebrated 
physician  of  that  time,  furnishes  us  exact  notions  of  the  mode  of  opera- 
ting practiced  by  the  Calabrians."  But  toward  the  close  of  the  same 
century,  we  find  no  longer  in  Calabria  any  trace  of  Bojano,  or  rhino- 
plasty. Gaspard  Tagliacozzi,  professor  of  surgery  in  the  University  of 
Bologna,  was  then  the  only  man  who  practiced  this  operation,  whether 
as  his  own  invention,  as  he  pretends,  or  as  acquired  from  the  descend- 
ants of  the  Calabrians.  Ambrose  Pare  recounts  the  history  of  a  cheva- 
lier 'of  Saint  Thoan,  who  after  having  for  a  loug  time  worn  a  silver 
nose,  was  by  the  skill  of  the  Italian  professor,  furnished  with  a  well- 
formed  nose  of  flesh.  In  1597,  Tagliacozzi  published  a  treatise  on  the 
art  of  restoring  the  nose  and  ears,  which  had  been  destroyed  or  muti- 
lated, f  Thomas  Fyens,  who  made  an  extract  from  this  work,  assures 
us  that  he  had  seen  several  persons  upon  whom  the  author  had  very 
happily  operated. |  Fabricius  of  Hilden,  reports  that  a  surgeon  of 
Lausanne,  named  Griffon,  having  possessed  the  knowledge  of  the  pro- 
cess of  Tagliacozzi,  repaired  so  well  the  nose  of  a  young  girl,  that 
twelve  years  after,  the  cicatrice  was  scarcely  perceptible.  In  fine,  John 
Baptist  Cortesi,  a  cotemporary  of  Tagliacozzi,  and  his  colleague  at  the 
University  of  Bologna,  gave  a  detailed  description  of  rhinoplasty,  which 
he  assures  us  he  had  himself  practiced. 

Xotwithstanding  these  undoubted  proofs,  the  art  of  restoring  the 
nose,  fell  again  into  oblivion,  for  nearly  two  hundred  years,  and  to  such 
a  point,  that  at  the  close  of  the  last  century  some  physicians  considered 
it  doubtful  whether  it  had  ever  existed,  when  a  journal  of  Madras  pub- 
lished, in  1794,  an  observation  of  rhinoplasty  executed  with  success  on 
an  Indian,  after  a  method  formerly  known  in  the  country.  This  pro- 
cedure consisted  in  detaching  from  the  skin  of  the  forehead,  a  flap,  out 
of  which  the  nose  was  to  be  formed,  while  the  Tagliacotian  operation 
consisted  in  taking  the  flap  from  the  arm,  in  the  deltoid  region.  The 
same  operation  was  afterwards  repeated  in  Prance,  England,  Germany, 
and  other  places,  with  various  modifications  and  results,  so  that  a  doubt 
about  its  reality  was  no  longer  permitted. 

DISEASES   OF   THE   MOUTH. 

Harelip,  or  split-lip,  an  infirmity  ordinarily  congenital  and  some- 
times accidental,  is  not  described  in  any  Greek  author.  Celsus,  who 
is  the  first  to  mention  it,  speaks  of  it  and  its  treatment,  only  in  a  very 
succinct  manner.     The  Arabian  writers  are  not  more  explicit,  with  the 

'^  De  Remedica  Opus  Basil  1539.    f  ^^  Curtorum  Chirurgia,  Venice,  1597. 
I  De  Praecipuis  Artis  Chirurgiae  Controversiis. 


446  REFORM    PERIOD. 

exception  of  Albucasls,  who  expresses  himself  about  it  with  more 
exactness  and  detail  than  all  his  predecessors.  He  advises  sometimes 
that  the  separated  borders  of  the  lip  be  cauterised,  to  excite  suppuration; 
sometimes  to  excise  them,  so  as  to  sew  them  together,  and  to  cover  the 
wound  with  an  ointment  of  dates.  After  him,  A.  Pare  was  the  first 
who  described  the  hare-lip  and  its  :pcration.  He  employed,  to  join  the 
freshened  edges  of  the  lip,  steel  needles,  around  which  he  wrapped  a 
waxed  thread,  in  the  form  of  the  figure  oo  •  Peter  Dionis  proved  that 
the  resection  is  always-  more  prompt  and  sure  than  cauterisation.  His 
idea  was  generally  adopted  and  still  prevails.  He  performed  the  exci- 
sion with  scissors ;  others  preferred  the  bistoui-y,  but  this  difi'erence  is 
of  but  little  importance.  The  steel  needles  have  been  replaced,  on 
account  of  their  rusting,  by  needles  of  silver  or  gold,  which  are  with- 
drawn more  easily,  without  tearing  the  flesh. 

DISEASES   OP   THE   TEETH. 

The  Art  of  Dentistry  formed  among  the  Egyptians,  as  it  does  yet  in 
many  countries,  a  particular  branch  of  Surgery,  and  was  practiced  by 
men  more  or  less  ignorant  of  the  rest  of  the  science.  Nevertheless,  phy- 
sicians have  also  occupied  themselves  with  it,  from  the  earliest  times. 
Erasistratus  speaks  of  an  odontagogue  of  lead,  which  was  suspended  in 
the  temple  of  Delphos,  to  indicate  that  only  such  teeth  as  were  greatly 
decayed,  should  be  extracted.  Hippocrates  gives  the  same  precept  • 
"  Extract,"  he  says,  "  the  carious  teeth  ;  but  when  they  are  neither  rot- 
ten nor  movable,  and  yet  cause  various  pains,  it  is  proper  to  apply  fire." 
Celsus  shares  the  same  opinion,  but  he  enters  into  much  more  detail,  on 
the  subject  of  the  operations  usually  performed  on  the  teeth.  "  Some- 
times," he  says,  "the  teeth  are  movable  because  the  roots  have  little  or 
no  hold,  and  the  gums  are  soft  and  fungous ;  in  either  case  the  surface 
of  the  gum  should  be  touched  lightly  with  the  hot  iron,  whenever  the 
tooth  is  carious.  Do  not  determine  too  quickly  to  extract  a  tooth,  unless 
it  be  utterly  necessary.  It  will  be  better  to  add  to  the  remedies  pre- 
scribed above,  more  efficacious  compositions  still,  to  calm  the  teeth,  such 
as  opium,  pepper,  and  sory,  rubbed  up  together,  and  incorporated  with 
galbanum,  which  is  to  be  applied  to  the  tooth.  If  medicaments  can  not 
appease  the  pain,  and  it  is  thought  best  to  extract  the  tooth,  it  must  be 
laid  bare,  and  moved  about  so  as  to  make  its  removal  easy,  for  there  is 
extreme  danger  in  attempting  to  draw  a  tooth  which  is  firmly  fixed  in 
its  alveolus.  When  the  teeth  are  black,  and  covered  with  tartar,  the 
dark  spots  must  be  removed  with  a  rasp,  and  the  teeth  rubbed  with 
an  opiate  composed,  in  part,  of  bruised  rose-leaves,  and  one-fourth  of 
nut-galls  and  myrrh."     Celsus  recommends,  also,    to  attach  the  loose 


f 

1 


EXTERNAL  PATHOLOGY  AND  THERAPEUTICS.  447 

teeth  to  the  adjoining  sound  ones  by  a  gold  thread.  When  in  children  the 
permanent  tooth  begins  to  press  upon  the  deciduous  one,  before  it  has 
dropped  out,  the  latter  one  must  be  extracted,  and  pressure  be  made  upon 
the  new  one  every  day,  so  as  to  constrain  it  to  take  the  place  of  the  other. 

Albucasis  is  the  first  who  spoke  of  dental  prothesis  ;  he  substituted  for 
a  lost  tooth  another,  either  natural  or  artificial,  which  he  fixed  to  its 
place  by  means  of  a  thread  of  gold  or  silver. 

The  ecclesiastic  physicians  of  the  middle  ages,  neglected  this  part  of 
the  art.  Guy  de  Chauliac  complains  loudly,  that  these  operations  had 
been  abandoned  to  the  barbers,  bath-keepers,  and  other  artizans,  deficient 
in  the  technical  knowledge  of  the  evolution  of  the  teeth  ;  operations  of 
such  importance  that  no  physician  should  disdain  to  undertake,  or  at 
least  to  assist  in  them.  A.  Pare  adds  to  the  laboratory  of  the  dentist 
several  instruments,  some  of  which  very  much  resemble  those  that  are 
now  employed.  He  is  the  first  one  who  reports  an  authentic  example  of 
an  extracted  tooth  being  immediately  returned  to  its  place;  and  become 
consolidated. 

In  the  course  of  the  eighteenth  century  the  Dentist's  Art  reached  a 
degree  of  perfection  it  had  never  before  approached.  Several  surgeons 
of  Paris,  Pierre  Fauchard,  Anselme  Jourdain,  Bunon,  and  Bourdet, 
contributed  especially  to  its  advancement,  as  well  by  their  practical 
skill  as  by  their  writings.  They  conferred  upon  the  hygiene  of  the 
mouth,  and  Dental  Surgery,  numerous  sage  precepts  and  useful  inven- 
tions. 

DISEASES   OP   THE   TOXGUE,    PAluiTE,    AND    TONSILS. 

The  operations  that  these  diseases  require,  sometimes  consist  in  scari- 
fications, excisions,  and  cauterizations.  We  find  them  mentioned,  more 
or  less  explicitly,  in  the  Hippocratic  works.  Celsus  describes  them 
with  more  or  less  details ;  he  speaks,  the  first,  of  the  resection  of  the 
frenum,  and  the  treatment  of  ranula.  Paul  of  iEgina  adds  something 
to  the  precepts  given  before  his  time  ;  but  the  Arabs  only  copied  the 
Greeks  on  this  branch  of  the  Art. 

The  moderns  have  contributed  additions  and  improvements  to  the 
above,  which  render  these  diseases  less  dangerous  and  more  easily  cured. 
They  have  also  signalized  some  diseases  of  which  the  ancients  have 
not  spoken,  such  as  salivary  fistula?,  which  are  frequently  met  with  in 
practice.  That  of  the  duct  of  Steno,  which  is  the  most  frequent,  was 
described  for  the  first  time,  by  Bartholomew  Saviard,  and  also  the  opera- 
tive proceeding  which  he  made  use  of  for  its  cure.  He  recounts  that  a 
man  named  De  Pioy.  having  pierced  his  cheek,  from  without  inwards, 
with  a  red  hot  iron,  at  the  point  of  the  fistula,  the  external  opening 
cicatrised,  while  the  internal  remained  open. 


448  REFORM   PERIOD. 


DISEASES    OP    THE    EAR. 

Among  the  affections  which  cause  a  loss,  more  or  less  considerable,  of 
the  faculty  of  hearing,  and  are  susceptible  of  being  relieved  by  the  aid 
of  surgery,  the  ancients  knew  only  the  occlusion  of  the  external  meatus, 
whether  congenital  or  accidental.  Paul  of  iEgina  is  the  only  one  of  all 
the  old  writers,  who  furnishes  on  this  subject  the  most  circumstantial 
and  rational  instruction.  Those  who  followed  him  changed  none  of  his 
prescriptions,  up  to  the  epoch  when  the  discoveries  of  Valsalva,  on  the 
structure  of  the  internal  ear,  gave  a  new  direction  to  the  therapeutics  of 
the  affections  of  this  organ.  That  illustrious  anatomist  was  the  first  to 
recognise  that  deafness  proceeds,  often,  from  the  obstruction  of  the 
Eustachian  tube.  He  perceived,  also,  that  the  cavity  of  the  tympanum 
communicates  with  the  cellules  of  the  mastoid  apophysis.  This  dis- 
covery was  accidentally  made.  While  injecting  a  carious  condition  of 
that  bony  eminence,  he  ascertained  that  the  lic^nid  passed  into  the  eso- 
phagus. Cheselden  several  times  observed  that  the  hearing  was  but 
little,  or  not  at  all  affected  by  the  perforation  of  the  tympanum. 

These  various  observations  led  to  the  discovery  of  several  ingenious 
processes,  for  the  cure  of  deafness  arising  from  some  affection  of  the 
internal  ear.  The  first  effort  made  to  this  end,  was  by  injection  through 
the  Eustachian  tube.  Anthony  Petit,  John  Douglass,  and  other  sur- 
geons of  the  eighteenth  century,  recommend  very  highly  this  means. 
Jasser,  a  surgeon  of  the  Prussian  army,  attempted  to  cure  the  deafness 
arising  from  the  occlusion  of  the  Eustachian  tube,  by  trephining  the 
mastoid  process,  and  pushing  injections  through  the  cells,  in  which  he 
succeeded  perfectly.  In  fine.  Sir  Astley  Cooper  conceived  the  idea  of 
perforating  the  tympanum,  to  replace  the  opening  of  the  obliterated 
Eustachian  tube ;  and  he  performed  the  operation,  successfully,  three 
times. 

OBTURATION    OF    THE   AIR     PASSAGES. 

When  the  air  passage  is  stopped  by  any  obstacle,  the  anguish  is 
extreme,  the  suffocation  iminent,  and  the  patient  speedily  dies,  unless 
promptly  succored.  This  accident  has  sometimes  occurred  in  a  violent 
quinsey,  but  more  frequently  in  the  fibrinous  effusion  in  children,  called 
croup.  The  Hippocratic  works  indicate  as  the  only  resource  in  this 
extremity,  to  pass  a  leek  leaf,  or  any  elastic  tube,  into  the  throat  of  the 
patient ;  but  this  agent  is  very  difficult  of  application,  and  I  doubt 
whether  it  was  ever  done  advantageously.  Asclepiades  of  Bythinia,  had 
the  idea  of  opening  a  passage  for  the  air,  by  making  an  incission  into  the 
larynx  or  trachea ;  but  the  authors  who  report  this  fact  do  not  describe 


EXTERNAL  PATHOLOGY  AND  THERAPEUTICS.  449 

the  operation  he  adopted.  After  him,  no  one  dared  attempt  tracheotomy 
until  Antyllus,  who  practiced  it  several  times,  and  described  his  mode 
of  operating.  "We  owe  to  Paul  of  ^gina  the  preservation  of  this 
precious  fragment.  The  Arabs,  and  the  Latins  of  the  middle  ages  had 
so  little  anatomical  knowledge  that  they  very  much  exaggerated  the 
dangers  of  the  operation,  and,  without  condemning  it  absolutely  in 
theory,  abstained  from  its  practice. 

Anthony  Benivieni,  a  physician  of  Florence,  who  lived  at  the  end  of 
the  fifteenth  century,  saved  the  life  of  a  patient  by  opening  the  trachea* 
and  giving  issue  to  the  pus  of  an  abscess  that  was  formed  within  it. 
This  is  the  first  account  we  have  of  a  tracheotomy,  after  an  interruption 
of  twelve  hundred  years  ;  but  its  author  does  not  state  the  manner  in 
which  he  performed  it,  and  it  does  not  appear  that  he  employed  this 
method  in  other  cases.  Fabricius  d'Aquapendente  is  the  first  among 
moderns  who  gives  a  detailed  description  of  this  operation.  He  proves 
that  it  may  be  executed  without  injury  to  any  other  important  organ ; 
and  that  by  it,  we  may  often  save  a  patient  from  impending  death. 
The  invention  of  the  canula  has  been  attributed  to  him,  which  has 
usually  been  left  for  some  time  in  the  artificial  opening  thus  made. 

DISEASES   OF   THE   CHEST. 

Empyema. — According  to  its  etymology,  the  word  signifies  a  collec- 
tion of  pus,  formed  in  any  part  of  the  body.  Many  authors  have 
employed  it  in  this  extended  sense  ;  thus  they  have  spoken  of  empyema 
of  the  brain — the  maxillary  sinus,  joints,  etc.  But  a  greater  number, 
especially  among  moderns,  use  the  word  empyema,  in  a  more  restricted 
sense,  only  employing  it  to  designate  a  purulent  or  aqueous  collection, 
enclosed  in  a  part  of  the  thoracic  cavity.  This  is  the  signification,  also, 
which  we  give  to  the  words.  Thus  we  understand  by  the  operation  for 
empyema,  an  opening  practiced  through  the  parieties  of  the  chest, 
to  give  passage  to  a  liquid  contained  in  one  of  its  cavities. 

We  are  astonished,  in  reading  the  Hippocratic  Works,  at  the 
assurance  with  which  they  frequently  repeat  the  advice  to  open  the 
throracic  cavity,  to  give  issue  to  the  empyema.  It  seems,  from  these 
works,  that  nothing  was  easier  than  to  recognize  the  presence  and  seat 
of  a  liquid  contained  in  the  chest.  Nevertheless,  they  do  not  always 
agree  among  themselves  on  the  symptoms  of  that  affection :  thus,  the 
author  of  the  treatise  on  the  Eegions  in  Man,  declares,  that  a  patient 
affected  with  empyema  expectorates  purulent  matter ;  while  the  author 
of  the  treatise  on  Internal  xiffections,  asserts  that  there  is  no  pus  either 
in  the  substances  expectorated  or  vomited.  It  is  said  in  a  passage  of 
the  second  book  on  Diseases,  that  the  patient  cannot  lie  on  the  painful 


450  REFORM    PERIOD. 

side;  and,  in  another  passage  of  the  same  book,  that  he  cannot  lie 
on  the  sound  side. 

Apart  from  these  small  contradictions  which  may  be  blamed  upon  the 
copyist,  the  following  are  some  of  the  signs  given  of  thoracic  effusion  : 
when  at  the  termination  of  a  pleuro-pneumonia,  which  has  existed  for 
some  time,  or  a  penetrating  wound  of  the  chest,  or  a  fluxion,  the  fever 
persists,  with  cough,  expectoration,  and  oppression — and  the  patient 
feels  pain  in  the  side  or  flanks,  and  realizes  an  extreme  lassitude — 
sweats  on  all  parts  of  the  body,  with  alternations  of  heat  and  cold, 
swelling  of  the  feet,  and  hooked  nails,  there  is  every  sign  of  the 
formation  of  an  empyema.  To  assure  yourself  better  and  to  know 
the  precise  point  of  collection,  require  the  patient  to  be  seated  on  a  solid 
chair,  and  direct  an  assistant  to  hold  his  hands,  then  seize  yourself  both 
shoulders,  and  shake  him,  and  listen,  attentively,  to  ascertain  from 
which  side  comes  the  sound  of  fluctuation.  You  will  realize  the  same 
sensation  as  when  you  agitate  a  leather  bottle  containing  liquid. 
When  this  sign  is  absent,  which  happens  often,  on  account,  either  of 
the  quantity  or  viscidity  of  the  liquid,  an  examination  must  be  made,  to 
ascertain  if  one  side  of  the  chest  is  not  more  swollen  than  the  other ; 
and,  in  that  case,  the  opening  should  be  made  a  little  below  or 
in  the  rear  of  the  tumor,  as  low  as  possible,  without  wounding  the 
diaphragm.  In  fine,  if  we  have  to  guide  us  neither  fluctuation  nor 
tumor,  and,  nevertheless,  the  symptoms  of  empyema  exist,  it  is  neces- 
sary to  spread,  on  a  cloth,  potter's-clay,  softened  with  warm  water,  and 
apply  it  to  the  chest ;  then,  with  a  brush,  dipped  in  some  coloring 
liquid,  mark  the  portion  of  the  skin  where  the  clay  dries  the  soonest ; 
this  will  mai'k  the  point  where  the  pucture  should  be  made. 

Thoracic  paracentesis  is  performed  as  follows :  after  having  incised 
the  skin  with  a  scalpel,  take  a  lancet  having  the  blade  wrapped  nearly 
to  the  point,  or  a  red  hot  iron,  and  plunge  the  instrument  into  the 
collection  of  pus,  and  let  it  flow  in  a  small  quantity.  The  opening  must 
be  closed  with  a  tampon  of  charpie,  fastened  to  a  thread,  which  will 
serve  to  draw  it  out ;  the  whole  is  to  be  supported  by  a  bandage  around 
the  body.  Twice  a  day  the  dressing  is  withdrawn,  giving  issue,  each 
time,  to  a  small  quantity  of  liquid.  When  it  is  sensibly  diminished, 
an  injection  is  to  be  made  of  warm  wine  and  oil,  to  prevent  the  lung, 
which  is  accustomed  to  humidity,  from  drying  too  quickly.  The  dress- 
ing is  thus  to  be  continued,  twice  a  day,  allowing  the  injection  of  the 
morning  to  flow  out  in  the  evening,  and  that  of  the  evening  to  flow  out 
in  the  morning.  When  the  cavity  furnishes  but  a  very  small  quantity 
of  humor,  a  curved  metallic  sound  should  be  introduced  every  day,  to 


EXTEKNAL   PATHOLOGY  AND  THERAPEUTICS.  451 

draw  off  what  is  collected.  Sometimes,  instead  of  incising  an  inter- 
costal space,  a  rib  may  be  perforated,  with  a  trephine,  which  will  allow, 
afterwards,  greater  facility  for  the  use  of  the  tampon.  Galen  cites  the 
history  of  a  child  whose  sternum  he  had  trephined,  to  give  issue  to  an 
abscess. 

After  him  the  operation  for  empyema  was  more  and  more  neglected ; 
neither  the  Greek  physicians  of  the  following  ages,  nor  the  Arabs,  nor 
the  Latins  of  the  middle  ages  practiced  it,  except  in  extremely  rare 
cases.  But  it  began  to  be  revived  in  the  course  of  the  sixteenth  cen- 
tury. Fabricius  d'Aquapendente  recommends  it  as  the  sole  resource 
that  the  art  possesses  against  pleuritic  inflammations  with  effusion — in- 
ternal abscesses,  penetrating  wounds — hydro-thorax — in  a  word,  against 
every  species  of  liquid  collection  which  cannot  be  evacuated  directly  by 
expectoration,  the  urine,  or  the  stools.  Being  an  enthusiastic  partisan 
of  the  ancients,  he  complains  that  in  his  time  thoracic  paracentesis  was 
not  practiced  as  frequently  as  it  had  been  under  the  Asclepiadffi.  But 
perhaps  they  may  be  reproached  for  having  practised  it  too  often !  The 
progress  of  surgery  is  not  measured  by  the  multiplicity  of  its  opera- 
tions ;  on  the  contrary,  its  greatest  improvement  consists  in  avoiding 
those  which  are  useless  or  very  dangerous.  Xow,  that  the  diagnosis  of 
empyema  is  carried  to  a  degree  of  perfection  much  higher  than  among 
the  ancients,  as  the  result  of  the  recent  discoveries  of  auscultation  and 
percussion,  thoracic  paracentesis  is  much  less  practiced  than  in  the  age 
of  Hippocrates. 

DISEASES    OP   THE   ABDOMINAL   OEGAXS. 

Wounds  of  the  Abdomen  and  Intestines. — Celsus  is  the  first  who  traces 
the  rules  for  the  suture  of  the  abdominal  parieties  and  the  intestines. 
He  remarks  as  follows :  When  a  wound  has  opened  the  abdominal  walls, 
it  often  happens  that  the  intestines  escape.  It  is  necessary  in  the 
first  place  to  examine  if  the  gut  has  been  injured,  and  preserves  its 
natural  colour.  If  the"  small  gut  is  wounded,  there  is  no  resource ; 
but  we  may  attempt  to  cure  a  wound  of  the  large  intestine  by  sewing 
together  the  lips  of  the  wound."  He  also  indicates  a  very  complicated 
method  to  execute  a  suture  on  the  abdominal  walls,  and  like  Galen, 
describes  two  others  which  differ  from  his,  which  in  all  make  three 
methods  of  gastroraphy  which  have  been  transmitted  to  us  by  the 
ancients. 

During  the  middle  ages  no  improvement  was  made  in  the  cure  of 
abdominal  and  intestinal  wounds.  Some  physicians  conceived  the  idea 
of  introducing  into  the  wounded  intestine,  before  uniting  the  edges  of 
the  wound,  a  tube  of  elder  pith,  in  order  to  prevent  the  escape  of  the 
feces  between  the  points  of  suture  ;  but  this  odd  procedure,  and  others 


452  REFORM   PERIOD. 

still  more  incredible,  sucli  as  the  Lites  of  ants,  were  justly  abandoned 
at  the  restoration  of  great  surgery.  There  was  a  return  to  the  plans 
of  the  ancients,  which  were  modified  in  an  advantageous  manner,  while 
at  the  same  time  new  additions  were  made.  Thus  Stalpaart  van  der 
Wiel  invented  the  method  of  establishing  an  artificial  anus,  and  for  the 
cure  of  wounds  of  the  large  intestine,  and  Peter  Dionis  generalised 
this  plan. 

PARACENTESIS   ABDOMINAXIS. 

While  the  Asclepiad^e  showed  themselves  empressed  and  bold  to 
advise  thoracic  paracentesis,  they  on  the  other  hand  appeared  to  have 
a  repugnance  of  paracentesis  abdominalis.  It  is  only  recommended  in 
a  single  passage  of  the  Hippocratic  writings,  and  in  a  very  succint 
manner,  the  author  simply  says  that  a  puncture  of  the  abdomen  must 
be  made  near  the  umbilicus,  or  in  the  rear,  in  the  region  of  the  flanks. 
An  aphorism  directed  that  but  a  small  amount  should  be  permitted  to 
flow  at  a  time,  when  an  opening  was  made,  either  with  the  knife,  or  the 
actual  cautery,  in  dropsy,  or  an  internal  abscess.  This  is  all  that  is 
found  in  that  antique  collection,  relative  to  abdominal  paracentesis. 
It  is  shown,  on  the  contrary,  by  a  great  number  of  physicians,  that 
ascitis  was  regarded  by  the  physicians  of  that  epoch,  as  an  affection 
entirely  beyond  the  resources  of  art,  and  nearly  always  mortal,  which  is 
doubtless  the  reason  why  they  so  rarely  had  recourse  to  an  operation, 
which  they  judged  to  be  more  injurious  than  useful,  in  such  cases. 

As  to  the  other  species  of  dropsy,  anasarca,  tumors  of  the  liver  and 
spleen,  they  advised  in  general  to  treat  them  by  scarifications  and  cau- 
terizations. 

Celsus  is  much  more  explicit  in  what  regards  the  diagnosis,  or  treat- 
ment of  dropsies,  of  which  he  distinguishes  three  kinds,  namely,  tym- 
panitic, leucophlegmatic  or  anasarca,  and  ascitis.  After  having  described 
the  characters,  and  the  means  of  cure  proper  to  each  of  these  species,  he 
says,  on  the  subject  of  the  last,  that  if  the  remedies  employed  to  dry  the 
bowels,  and  arrest  the  humor,  do  not  produce  the  desired  effect,  it  is 
necessary  to  evacuate  the  fluid  in  a  shorter  way,  by  making  a  punc- 
ture. Then,  in  another  book,  he  describes  in  detail  the  method  of 
making  the  puncture.  He  directs  that  the  abdomen  be  incised  at  the 
umbilicus,  even,  or  at  four  fingers  width  from  the  left  side,  with  a  nar- 
row bistoury,  and  then,  that  a  cannula,  with  a  projecting  and  reversed 
edge,  be  introduced  at  the  opening.  That  being  done,  a  good  part  of  the 
water  is  permitted  to  run  out;  then  the  cannula  is  plugged  with  a 
tampon,  and  is  kept  in  its  place  by  a  bandage  around  the  body.  The  next 
day  the  remaining  water  is  gradually  evacuated.  There  are  surgeons, 
he   adds,  who  withdraw   the   cannula  on  the  first  day,  and   who   fix 


EXTERNAL  PATHOLOGY   AND   THERAPEUTICS.  453 

in  the  opening  a  piece  of  sponge  saturated  with  vinegar,  or  water.  The 
next  day  the  cannula  is  re-introduced,  and  the  evacuation  is  completed. 
During  the  centuries  after  Galen,  not  only  were  no  improvements 
made  on  the  rules  given  by  Celsus,  but  rather  a  retrograde  movement 
took  place  toward  the  practices  of  the  Asclepiad^e,  viz  :  they  preferred 
cauterizations  and  scarifications  to  the  paracentesis.  This  latter  method 
did  not  come  into  vogue  again  till  the  fourteenth  century.  Mondini 
objected  to  its  being  practiced  at  the  llnea  alba,  because,  he  says,  the 
tendinous  nature  of  the  structure  here,  makes  the  cicatrization  more 
difficult,  and  often  provokes  spasmodic  accidents.  Fabricius  d'Aqua- 
pendente  believed  that  it  could  be  executed  at  the  umbilicus  with  less 
danger  than  at  any  other  point.  John  Palfyn  chose  the  middle  of  a  line 
drawn  from  the  navel  to  the  left  anterior  superior  process  of  the  ilium, 
and  this  is  to-day  the  point  selected,  when  any  particular  circumstance 
does  not  require  some  other  one  to  be  chosen.  At  the  same  time  much 
attention  was  paid  to  the  improvement  of  the  instruments  employed  in 
the  operation.  Sanctorius  invented  one  which  made  much  noise,  because 
he  kept  it  secret  for  a  long  time.  It  consisted  in  a  round  needle,  con- 
tained io  a  cannula.  It  was  in  fact  almost  the  same  as  our  trochar.  In 
short,  we  owe  to  two  modern  surgeons,  and  particularly  to  those  of  the 
last  century,  the  knowledge  of  encysted  dropsy,  which  had  escaped  the 
attention  of  the  ancients.  H.  F.  Ledran  was  the  first  to  trace,  in  a  pre- 
cise manner,  the  diagnosis  and  treatment  of  this  affection. 


This  word,  in  its  vulgar  and  primitive  acceptation,  and  it  is  that 
which  we  adpot  here,  signifies  nothing  more  than  a  tumor  formed  by  the 
displacement  of  some  of  the  viscera  of  the  bowels.  Though  the  tumors 
of  that  sort  may  show  themselves  on  nearly  all  parts  of  the  abdominal 
surface,  the  ancients  have  only  signalized  those  that  appear  at  the  groin, 
or  umbilicus.  They  studied  particularly  the  former,  because  they  were 
most  frequent,  their  diagnosis  often  obscure,  and  their  treatment  very 
difficult. 

Celsus,  who  was  the  first  to  describe  inguinal  hernia,  expresses  him- 
self in  the  following  terms.  "  The  peritoneum,  which  separates  the 
intestines  from  the  parts  above  the  groin,  is  subject  to  be  torn,  either  as 
the  result  of  inflammation,  or  the  effect  of  a  violent  blow :  then  the 
epiploon,  or  intestine,  being  drawn  down  Ly  its  own  weight,  becomes 
engaged  in  the  opening,  separating  gradually  the  nervous  tunics  that 
envelope  the  testicle."  In  this  manner  the  Eoman  encyclopedists 
explained  the  formation  of  inguinal  hernia.  Ihe  other  writers  of  anti- 
quity and  of  the  middle  ages,  made  no  change  in  this  explanation,  and 


454  REFOKM    PERIOD. 

it  was  only  at  an  epoch  very  close  to  our  own  that  the  error  was  discov- 
ered and  demonstrated,  as  we  shall  show  presentl3\ 

In  regard  to  its  cure,  Celsus  advised  to  attempt  it  without  using  the 
bistoury,  but  he  laid  down  no  rule  for  the  practice  of  the  taxis.  He 
contents  himself  by  saying,  after  having  returned  the  intestine,  that  it 
was  necessary  to  retain  it  by  means  of  a  truss,  which  often  provokes  the 
adhesion  of  the  membranes,  especially  in  very  young  children.  When 
it  is  necessary  to  use  a  sharp  instrument,  let  it  be  done  as  follows : 
after  having  incised  the  first  tegument  of  the  tumor,  the  envelopes  of 
the  testicle  must  be  dissected  as  carefully  as  possible,  so  as  not  to  injure 
that  organ  ;  the  herniated  viscus  is  freed  from  its  envelopes  and  returned 
to  the  abdominal  cavity,  through  the  peritoneal  opening,  which  is  enlarged 
as  much  as  is  needed.  As  the  incision  of  the  tissues  goes  on,  it  is  neces- 
sary to  tie  the  larger  vessels.  At  the  close  of  the  operation  the  borders 
of  the  wound  are  brought  together  by  some  points  of  suture,  and  the 
threads  are  left  to  fall  ofi"  of  themselves,  which  takes  place  as  soon  as 
suppuration  is  established. 

Celsus,  as  is  seen,  gives  directions  to  have  as  much  care  of  the  testi- 
cle as  possible.  Paul  d' J2gina  confirms  the  precept  of  Celsus,  and  the 
Arabian  writers  only  copy  the  Greeks  on  this  subject ;  but  they  abstain 
from  practicing  the  operation  themselves ;  their  natural  repugnance  to 
the  employment  of  cutting  instruments  being  fortified  on  this  occasion 
by  a  misplaced  modesty.  They  limit  themselves,  in  the  cure  of  this 
infirmity,  to  the  use  of  agglutinative  and  astringent  plasters.  The  sur- 
geons of  the  middle  ages  established  the  absurd  rule  of  tying,  in  these 
cases,  the  spermatic  cord,  and  taking  away  the  testicle. 

Ambrose  Pare  brings  back  the  treatment  of  inguinal  hernia  to 
sounder  ideas.  He  proscribes  the  removal  of  the  testicle,  except  in 
cases  of  gangrene  or  sarcocele  only.  Pierre  Franco  refutes  the  errors 
of  the  ancients,  relative  to  the  rupture  of  the  peritoneum;  he  shows 
that  ordinarily  that  membrane  accompanies  the  viscera,  when  they 
emerge  from  tlie  abdominal  cavit}",  without  rupturing  it.  From  that 
time,  the  diagnosis  and  therapeutics  of  hernia  acquired  a  precision 
which  they  had  never  before  approached,  thanks  to  the  labors  of  a  great 
number  of  surgeons,  of  the  seventeenth  and  eighteenth  centuries, 
among  whom  we  may  cite  Jean-Louis  Petit,  Leblanc,  P.  Camper,  Samuel 
Sharp,  A.  Louis,  Percival  Pott,  Auguste  Eichter,  Antoine  Gimbernat, 
and  A.  Bonn. 

DISEASES  OP    URINARY    ORGANS. 

Among  the  very  varied  operations  to  which  these  diseases  have  given 
rise,  up  to  this  period,  the  gravest,  undoubtedly,  are  nephrotomy  and 


I 


EXTERNAL   PATHOLOGY   AND   THERAPEUTICS,  455 

cystotomy.  The  first  is  recommended  in  the  Hippocratic  writings,  but 
the  manner  of  executing  it  is  nowhere  described.  The  second,  though 
less  dangerous,  is  mentioned  in  only  one  of  the  works  of  that  collection, 
and  only  to  proscribe  it.  We  read  in  the  oath  of  Hippocrates,  "  I  swear 
not  to  cut  any  person  attacked  with  stone.  I  will  abandon  that  prac- 
tice to  the  mercenaries  who  devote  themselves  to  it."  ^Vhy  did  the 
Asclepiadae,  who  did  not  hesitate  to  recommend  the  cutting  into  the 
kidney,  show  so  much  repugTaance  for  cutting  into  the  bladder,  an  opera- 
tion less  difficult  and  less  fatal  than  the  other  ?  However  this  may  be, 
the  prejudice  that  excluded  cystotomy  from  the  domain  of  the  Art, 
became  extinct,  or  was  very  much  abated  in  the  school  at  Alexandria, 
since  Celsus  names  two  distinguished  lithotomists  of  that  school,  Ammo- 
nius  and  Meges,  whose  methods  of  operation,  as  well  as  their  intentions 
and  curative  views,  he  does  not  disdain  to  mention. 

"  We  are  sometimes  obliged,"  he  says,  "  to  employ  the  aid  of  the 
hand,  not  only  among  men,  but  also  in  women,  to  press  out  the  urine 
which  is  retained,  either  because  the  urinary  conduit  is  diminished  by 
reason  of  advanced  age,  or  because  there  is  some  stone  or  clot  of  blood 
which  stops  the  passage,  or  a  slight  inflammation,  which  often  occurs, 
and  stops  the  natural  flow  of  the  urine.  To  efi'ect  this,  sounds,  made 
of  brass,  are  employed,  and  the  surgeon  must  never  have  less  than 
three  for  men  and  two  for  women,  so  as  to  be  able  to  assist  all  persons, 
great  or  small.  Since  we  have  mentioned  the  bladder  and  stone,  it 
would  appear  that  this  is  the  place  to  speak  of  the  operation  which  we 
are  obliged  to  practice  on  those  who  are  attacked  with  stone,  when  a 
cure  can  not  otherwise  be  eff'ected :  for  no  haste  must  ever  be  made  to 
perform  this  dangerous  operation,  neither  must  it  be  executed  at  all 
seasons  or  ages,  nor  in  all  kinds  of  cases,  but  only  in  the  spring,  and 
on  children  from  nine  to  fourteen  years  of  age,  and  when  the  suff'ering 
is  so  great  that,  not  yielding  to  other  remedies,  the  patient  is  continually 
in  danger  of  perishing." 

After  having  thus  presented  the  indications  which  establish  the 
necessity  of  operating,  Celsus  describes,  with  great  detail,  the  sole  opera- 
ive  proceeding  known  in  his  time,  and  designated  by  moderns  under 
the  name  of  minor  operation,  j^^tit  appareil.  His  description  has 
remained  as  a  model,  which  the  writers  who  followed  him,  whether 
Greeks,  Arabs,  or  Latins,  did  in  no  respect  change  until  within  a  period 
not  far  removed  from  ours.  During  the  middle  ages,  cystotomy  left  the 
domain  of  the  regular  practice,  and  fell  into  the  hands  of  men,  stran- 
gers to  medical  science,  who  went  from  city  to  city,  according  to  the 
expression  of  the  times,  to  cut  the  calculous,  (couper  les  calculeiix.) 
(xuy  de  Chauliac  appears  to  have  been  the  sole  surgeon  of  that  age  who 


456  KEFORM   PERIOD. 

dared  attempt  or  advise  such  an  operation,  and  he  followed,  literally, 
the  method  of  the  Eoman  encyclopedist. 

About  the  commencement  of  the  sixteenth  century,  John  de  Eomani, 
surgeon  of  Cremona,  and  the  Neapolitan,  Mariano  Santo  de  Barletta, 
made  some  changes  in  the  old  method ;  they  added  several  instruments 
of  their  invention  to  those  which  had  been  employed  up  to  that  time. 
Mariano,  having  made  known  his  changes  in  a  memoir,  ex-professo,  the 
new  method  of  operation  was  termed  the  method  of  Mariano,  from  the 
name  of  its  author,  or  great  operation,  grand  appareil,  on  account 
of  its  complication,  and  of  the  number  of  instruments  that  were 
employed  in  it.  The  family  of  Colot  has  given  to  France  several 
lithotomists  who  became  celebrated  by  the  employment  of  the  grand 
appareil. 

About  the  time  that  Mariano  published  the  details  of  his  operation, 
another  surgeon,  a  native  of  France,  and  residing  at  Lausanne,  was 
led  by  necessity  to  the  discovery  of  another  procedure,  more  important 
still,  and  named,  afterward,  the  high  operation.  We  will  let  him  tell 
himself  the  circumstances  which  led  him,  very  much  against  his  will, 
to  open  a  new  route.  "  I  will  recite,"  he  says,  "  what  happened  to  me 
once.  Desiring  to  take  a  stone  from  a  child  of  about  two  years  of  age, 
but  finding  a  stone  nearly  of  the  size  of  a  pullet's  egg,  I  did  all  I  could 
to  withdraw  it  downward,  and  seeing  that  I  could  not  advance  it  with 
all  my  efforts,  and  that  the  patient  was  excessively  tormented,  and  also 
that  the  parents,  wishing  that  he  might  die,  rather  than  live  in  such  a 
condition,  joined,  also,  to  the  feeling  that  I  was  not  willing  to  bear  the 
reproach  of  not  being  able  to  take  it  away,  (which  was  very  foolish  in 
me)  I  deliberated,  with  the  importunity  of  the  father,  mother,  and 
friends,  to  cut  the  child  above  the  os  pubis,  inasmuch  as  the  stone 
could  not  descend  downward.  He  was  cut  over  the  pubis,  a  little  to 
one  side,  for  I  held  the  stone  there  with  my  fingers,  which  were  in  the 
fundament,  and  it  was  also  held  on  the  other  side  by  the  hands  of  an 
assistant,  who  compressed  the  little  belly,  above  the  stone.  I  then 
extracted  it,  and  the  patient  was  cured,  though  he  was  very  ill.  and 
the  wound  consolidated." 

Notwithstanding  this  result,  the  method  imagined  with  so  much 
success  by  Peter  Franco,  remained  in  obscurity  until  in  the  year  1580, 
when  Francis  Rousset  attempted  to  revive  it,  and  argued  that  it  pre- 
sented no  more  inconveniences  than  the  others,  and  had  several  advan- 
tages above  them.  Nevertheless,  his  argument  did  not  succeed  in 
establishing  the  operation  above  the  pubis,  as  the  common  operation, 
but  only  as  one  that  might  be  employed  in  rare  cases.  John  Douglass, 
a  celebrated   surgeon  of  the  eighteenth   century,   was   the   first  who 


EXTERNAL   PATHOLOGY   AND   THERAPEUTICS.  457 

employed,  habitually,  the  Itigh  operation,  in  preference  to  the  other 
methods. 

A  man,  whose  complete  defect  of  anatomical  knowledge  would  exclude 
him  from  the  practice  of  surgery  in  an  enlightened  age,  named  Baulot, 
or  Beaulieu,  better  known  under  the  name  of  Friar  James,  enriched 
science  with  a  process  of  cystotomy  which  is  not  behind  any  of  the 
preceding,  and  is  designated  as  the  lateralized  method.  The  Hollander, 
Eaw,  being  initiated  by  him  into  this  method,  employed  it  with  extra- 
ordinary success  ;  but  he  dishonored  himself  in  not  communicating  it 
to  any  one,  and  carried  the  secret  to  his  grave.  After  his  death,  a 
crowd  of  surgeons,  desirous  of  discovering  the  lost  secret,  devoted 
themselves  to  researches  which  were  not  fruitless.  On  one  hand,  Wil- 
liam Chcselden  resuscitated  the  lateral  method,  and  after  having  added 
several  improvements,  gave  it  a  perpetual  existence,  by  the  description 
which  he  published  ;  ••'  on  the  other  hand,  Peter  Foubert  invented  a  new 
method,  which  has  taken  rank  in  science  under  the  name  of  the  lateral 
method,  and  which  Thomas,  surgeon-in-chief  of  Bicetre,  adopted  the 
first,  and  modified  it. 

Thus,  to  a  single  method,  which  the  ancients  transmitted  to  us,  the 
moderns  have  added,  before  the  close  of  the  last  century,  four  others, 
each  of  which  presents  particular  advantages  and  disadvantages  ;  so 
that  the  man  of  art  may  accord  his  preference  to  either,  according  to 
circumstances  and  the  occasion. 

DISEASES   OF   THE   GENITAL   ORGANS   IN   MAN. 

Hydrocele. — Celsus  was  the  first  who  treated  of  this  disease,  which 
he  described  very  imperfectly^  under  the  name  of  aqueous  hernia.  He 
advised  the  excision  of  the  organs,  in  order  to  evacuate  the  liquid,  and 
to  wash  the  wound  afterward  in  a  salt  of  nitre.  Galen  employed  the 
seton  to  cure  the  same  disease,  the  diagnosis  of  which  he  did  not  estab- 
lish in  a  manner  more  explicit  than  Celsus.  Leonidas  of  Alexandria 
described  hydrocele  with  more  exactness  ;  he  endeavored  to  fix  the 
characters  which  separate  it  from  sarcocele,  enterocele,  and  epiplocele. 
Paul  of  ^gina  first  distinguished  dropsy  of  the  tunica  vaginalis,  from 
infiltration  of  the  cellular  tissue.  He  treated  both,  either  by  excision 
or  cauterisation.  Albucasis  preferred  the  actual  cautery  to  excision  ; 
nevertheless,  he  also  taught  the  manner  of  evacuating  the  water  with 
a  trochar,  or  to  excise  the  sack,  when  there  was  one. 

Thus,  at  the  epoch  of  the  revival  of  letters,  four  methods  of  treating 
hydrocele  were  known,  namely,  excision,  the  seton,  cauterization,  and 

"  Treatise  on  the  High  Operation  for  Stone.     London,  1723. 

29 


458  REFORM  PERIOD. 

puncture.  The  modems  have  added  a  fifth,  stimulating  injection  after 
paracentesis,  the  first  mention  of  which  was  made  by  Alexander  j^lonro. 
Besides,  they  have  determined  much  better  its  seat,  and  the  various 
characters  and  species  of  the  disease. 

Sarcocele,  or  cancer  of  the  testicle,  is  the  only  disease  which  requires 
the  sacrifice  of  the  organ  of  virility  ;  but  this  terrible  operation  was  for- 
merly much  more  employed.  Celsus,  who  first  names  it,  enumerates 
three  species  of  tumors  which  require  its  employment,  namely:  circocele, 
or  the  varicose  dilatation  of  the  spermatic  cord,  sarcocele,  and  violent 
inflammation  of  the  testicles.  In  the  course  of  time,  the  supposed 
necessity  for  the  operation  was  not  even  thus  limited ;  it  was  extended, 
as  before  said,  to  hernia  ;  recourse  was  also  had  to  it  in  the  treatment  of 
elephantiasis,  leprosy,  gout,  and  even  mental  alienations.  There  was  a 
time  when  ignorance  and  cupidity,  united,  seemed  to  have  determined  on 
the  destruction  of  the  reproductive  organs  in  man.  These  pretended 
curers  overspread  the  countr}^  and,  for  a  moderate  sum,  castrated  chil- 
dren, under  the  pretext  of  curing  them  of  hernias  which  they  did  not 
have,  or  which  they  might  have  been  rid  of  without  this  odious 
mutilation.  The  abuse  was  carried  to  such  an  extent  that  the  Eoyal 
Society  of  Medicine  became  excited.  In  1776  it  named  a  committee  to 
make  a  report  on  the  subject,  and  devise  means  to  put  a  stop  to  this 
prodigality  of  mutilations.  It  was  shown  that  in  the  diocese  of  Saint 
Papoul  alone,  more  than  five  hundred  little  boys  were  cut  by  the  auda- 
cious charlatans,  who  received  thirty-five  livres  for  every  operation  of 
that  nature.  Haller  assures  us  that  in  the  Swiss  cantons,  there  existed, 
in  his  time,  a  number  of  men  deprived  of  testicles  for  the  same  cause. 
Let  us  felicitate  modern  surgei-y  for  having  reduced  the  necessity  of  cas- 
tration to  excessively  rare  cases. 

Though  we  have  limited  ourselves  to  present  the  history  of  this  opera- 
tion in  a  medical  point  of  view,  it  is  proper  to  say  that  long  before  science 
had  dared  avail  herself  of  this  extreme  resource,  in  diseases  deemed 
incurable,  human  passions,  polities,  jealousy  and  vengeance,  had  invented 
this  cruel  means,  and  had  not  hesitated  to  exercise  it  on  a  grand  scale. 
Eunuchs  were  common  in  Egypt,  Assyria,  and  other  countries  of  the 
East,  even  before  Moses,  while  castration,  as  a  therapeutic  resource,  was 
not  employed  till  after  Hippocrates.  But  do  the  passions  count  the  suf- 
ferings, or  even  the  lives  of  men  as  anything,  when  they  wish  to  gratify 
their  ends  ?  The  custom  of  mutilating  young  boys  to  preserve  their 
tone  and  extent  of  voice,  which  is  lost  at  puberty,  was  kept  up  in  Italy 
to  a  recent  period,  notwithstanding  the  denunciation  of  both  religion  and 
the  laws  ;  and  avaricious  parents  have  been  known  to  ofier  their  children 
to  this  degradation. 


EXTERNAL   PATHOLOGY   AND   THERAPEUTICS.  459 

DISEASES     or     THE     ANUS. 

A  single  one  of  these  diseases,  tlie  anal  fistula,  demands  special  aid 
from  surgery.  We  are  astonished  in  reading  the  little  Hippocratic 
treatise  relative  to  this  affection,  at  the  exactness  with  which  the  treat- 
ment it  requires  is  there  traced.  The  most  of  the  curative  means  now 
advised  in  such  circumstances,  are  there  already  enumerated ;  and  the 
writers  of  later  periods,  until  the  period  of  the  revival  of  learning,  added 
very  little  to  the  details  furnished  in  this  monograph,  which  is  one  of 
the  most  precious  treatises  of  Hippocratic  surgery. 

DISEASES     OF     THE     MEMBERS. 

External  Aneurisms. — Aneurisms  may  exist  in  all  parts  of  the  body, 
but  they  are  not  susceptible  of  surgical  treatment  except  when  seated  in 
the  members ;  and  it  is  on  this  supposition  only  that  we  take  it  up. 
Before  the  anatomical  discoveries  of  the  Alexandrian  school,  only  inexact 
and  erroneous  ideas  could  be  held  on  the  subject  of  aneurisms.  At  that 
time  the  arteries  and  veins  were  confounded  together ;  and  when  they 
were  known  to  be  distinct,  the  arteries  were  supposed  to  contain  air, 
and  not  blood.  Celsus  was  not  ignorant  that  the  arteries  contained 
blood,  for  he  affrms  that  a  wounded  artery  does  not  cicatrise,  and  some- 
times allows  the  blood  to  escape  with  great  violence ;  but  he  makes  no 
mention  of  the  morbid  dilatation  of  that  order  of  vessels.  Philagrius 
is  the  first  who  has  spoken  of  it,  and  who  has  indicated  the  means  to 
remedy  this  accident.  That  bold  surgeon  passed  a  ligature  above  and 
below  the  tumor ;  then  he  excised  it  and  filled  the  wound  with  medica- 
ments, to  establish  supuration.  Antyllus  employed,  equally,  the  double 
ligature ;  but  instead  of  excising  the  tumor  he  was  contented  with 
emptying  it  of  the  clot  of  blood  which  it  contained,  and  filling  up  the 
cavity  with  materials  to  promote  supuration.  In  fine,  in  the  fifteenth 
century  John  de  Vigo  conceived  the  plan  of  treating  aneurismal  tumors 
by  gradual  compression  and  styptics.  Xothing  has  been  added  since,  to 
the  modes  of  treatment  we  have  just  enumerated ;  on  the  contrary 
excision  has  been  abandoned  as  always  useless,  and  often  dangerous ; 
but  great  improvements  have  been  made  in  the  manner  of  executing  the 
ligature  and  compression,  as  well  as  everything  that  belongs  to  the  diag- 
nosis of  the  disease. 

ON    AMPUT.iTION   OF   MEMBERS. 

A  multitude  of  circumstances  may  demand  the  necessity  of  having 
recourse  to  this  melancholy  resource — the  last  of  all,  but  sometimes  the 
only  one  to  save  the  life  of  the  patient ;  nevertheless,  there  is  only  one 
allusion  made  to  it  in  the  Hippocratic  writings,  which  is  in  the  following 


460  REFORM    PERIOD. 

terms:  "When,  as  the  result  of  a  fracture,  gangrene  with  discolora- 
tion supervene  suddenly,  the  whole  body  perishes.  If  the  bone  has  been 
taken  off,  the  flesh  which  must  fall  is  promptly  separated ;  but  if  the 
bone  remains  sound,  though  the  flesh  quickly  falls,  it  exfoliates  slowly 
where  it  has  been  left  uncovered  by  the  gangrene.  Everything  must 
be  removed  from  the  articulation,  above  the  gangrene,  having  care  not  to 
touch  any  living  part ;  for  if  the  operator  touches  that  which  is  sensible, 
in  cutting  a  part  which  is  not  entirely  dead,  the  patient  is  exposed  to 
pains  which  produce  sometimes  their  death."  It  is  easy  to  see  by  this 
passage,  even,  that  the  complete  amputation  of  a  member,  of  both  flesh 
and  bone,  was  rarely,  if  ever,  practised  among  the  Asclepiadse :  for  they 
were  not  ignorant  that  it  was  less  the  pain  than  the  hemorrhage  or 
inflammation  that  causes  patients  to  perish.  But  what  most  proves 
liow  little  skillful  they  were  to  practice  amputation,  is,  that  they  make 
no  mention  of  this  surgical  means  even  where  it  would  be  most  indi- 
cated. It  was  jirobably  the  surgeons  of  Alexandria  who  dared  the  first 
to  attempt  this  grave  operation.  Celsus  counseled  it  in  cases  where 
gangrene  attacks  a  member  without  having  also  attacked  the  trunk, 
though  he  avows  that  there  is  extreme  peril  in  doing  it.  "But,"  he 
.adds,  "  when  it  is  the  only  resource,  there  must  be  no  hesitation  about 
employing  it,  whatever  uncertainty  may  accompany  it."  He  also  recom- 
mends that  the  amputation  be  made  between  the  dead  and  the  sound 
parts,  in  such  a  manner  as  to  affect  much  more  the  latter,  and  alwaj'S 
keeping  as  far  as  possible  from  the  articulation.  When  the  bone  was 
reached,  he  advised  to  saw  the  bone  as  high  as  possible,  so  that  more 
flesh  would  remain  to  cover  the  stump. 

The  method  of  great  amputations  received  but  few  modifications  in  the 
centuries  of  decadence  which  followed.  As  the  most  immediate  danger 
in  all  these  cases  is  always  from  hemorrhage,  it  was  conceived  best,  in 
order  to  avoid  it,  to  cauterize  the  stump  with  a  red-hot  iron,  with  boil- 
ing pitch,  or  other  escharotic  substances.  But  there  resulted  from 
these  methods,  as  may  well  be  supposed,  atrocious  pains  and  fearful  in- 
flammations, which  must  have  carried  off  most  of  the  patients,  and 
disgusted,  likewise,  the  operators.  It  was  on  this  account  that  Guy  de 
Chauliac  recommended  to  let  the  part  full  off  itself,  rather  than  recur 
to  the  operation. 

A  new  era  dawned  on  this  capital  branch  of  surgery,  when  A.  Pare 
substituted  the  ligature  of  the  arteries  for  cauterization,  in  the  first 
dressing.  From  that  epoch  successive  improvements  were  introduced 
both  in  the  mode  of  operation,  as  well  as  in  the  consecutive  treatment. 
There  was  much  discussion,  also,  on  the  dangers  and  advantages  of  im- 
Tnediate  or  deferred  amputations.    At  the  head  of  the  surgeons  who 


EXTERNAL   PATHOLOaY   AND  THERAPEUTICS.  461 

concurred  in  these  improvements,  and  took  an  honorable  part  in  those  great 
discussions,  I  will  cite  D.  Anel,  .Teau  Louis  Petit,  H.  F.  Ledran,  Anthony 
Louis,  Ulric  Bilguer,  Brasdor,  Benjamin  Bell,  Peter  Joseph  Desault,  and 
John  Hunter. 

ON     O  R  T  H  O  P  ^K  II I  A  . 

The  first  who  wrote  a  special  treatise  on  this  branch  of  surgery  was 
Xicholas  Audry,  who  defined  it  an  art  to  correct  the  deformities  of 
the  body,  in  young  subjects.  That  definition  is  clear,  conformable  to 
etymology,  and  seems  to  us  to  indicate  well  the  end  that  is  proposed  in 
this  branch  of  the  Art,  and  we  therefore  think  we  cannot  do  better  than 
retain  it.  We  find  in  the  most  ancient  books  of  Medicine  some  traces 
of  orthopgedia,  and  notably  in  the  Hippocratic  treatise  on  Articulations, 
where  we  read,  among  othei'S,  the  following  passage :  "  There  are  also 
some  congenital  luxations  which,  if  the  displacement  is  small,  are  sus- 
ceptible of  being  reduced,  especially  those  that  affect  the  articulations 
of  the  feet.  The  natural  club-foot  of  birth  is  curable,  in  most  cases, 
when  the  deviation  is  not  very  great,  and  the  child  is  not  too  old.  The 
best  way  is  to  treat  the  deformity  as  speedily  as  possible — before  the 
bones  are  greatly  diminished  and  the  flesh  is  greatly  reduced.  There  is 
not  only  a  single  species  of  club-foot — there  are  several  of  them  ;  but  the 
greater  part  are  not  complete  luxations,  but  deviations  of  the  foot  in- 
ward, and  retained  by  some  means  in  a  constant  position.  The  following 
points  are  necessary  to  observe  in  the  treatment."  '••'  The  author  then 
traces,  with  much  detail,  the  curative  method  in  these  deformities. 

All  the  surgical  works  which  have  been  written  since,  include  some 
fragments  relative  to  the  same  subject;  but  these  documents  disseminated 
in  the  midst  of  other  subjects,  in  various  chapters,  do  not  form,  in  any 
respect,  a  body  of  doctrine.  Before  the  last  century,  no  one  had  dreamed 
of  extracting  them  and  uniting  them,  with  special  reference  to  ortho- 
piedia ;  it  was  then  a  rare  and  happy  idea  to  call  the  attention  of  prac- 
titioners to  this  special  object,  which  must  sooner  or  later  contribute  to 
the  physical  perfection  of  the  human  species.  Though  the  work  of  M. 
Andry,  which  was  the  most  important  that  was  published  in  the  course 
of  the  eighteenth  century,  contains  the  usual  imperfections  of  a  first 
essay,  it  is  not  without  merit  at  the  present  time  ;  for  it  contains  judi- 
cious precepts — observations  full  of  sagacity,  though  occasionally  in 
contact  with  prejudices  and  errors,  often  ridiculous.  We  will  also  point 
out,  as  worthy  of  being  consulted,  the  works  of  Levacher  de  la  Feutrie, 
J.  Venel,  Anth.  Portal,  etc. 

■'  OEuvres  d'Hippocrate,  by  Littre — on  Articulations. 


462  REFORM   PERIOD. 

CHAP  TEE    VII. 
OBSTETRICS. 

We  have  seen  that  the  art  of  accouchement  remained  very  much  in  the 
rear  of  other  branches  of  surgery,  notwithstanding  the  very  estimable 
efforts  of  some  surgeons,  to  draw  it  fx'om  the  state  of  abjection  in  which 
it  vegetated.  But  a  very  particular  cause  was  an  obstacle  to  its  pro- 
gress. The  most  of  the  women  employed  in  childbed,  were  ignorant  old 
matrons,  who,  attached  to  their  old  routine,  which  had  been  followed 
from  time  immemorial,  repelled  all  innoTation.  Accoucheurs  were 
called  in  extraordinary  cases  only,  where,  from  the  grave  and  urgent 
circumstances,  they  could  not  acquii'e,  except  with  difficulty,  the  expe- 
perience  that  inspires  useful  reforms.  However,  the  prejudices  that 
excluded  them  from  the  pi-acticc  of  midwifery,  gradually  gave  way,  and 
a  new  era  opened  for  obstetrics. 

In  the  beginning  of  the  seventeenth  century  a  sage-femme,  Louisa 
Bourgeois,  called  Boursier,  sage-femme  of  'Marie  de  Medicis,  made  an 
exception  to  the  common  rule,  by  publishing  a  collection  of  observations,'--' 
in  which  we  meet  with  several  new  idcas.f  Tinally,  the  art  of  accouche- 
ments  came  forth  from  its  beaten  path,  to  assume  a  reform  truly  scientific, 
based  on  rational  principles,  when  Francis  Mauriceau,  accoucheur-in- 
chief  of  the  Hotel  Dieu,  in  Paris,  published  his  treatise  on  the  diseases 
of  pregnant  women,  and  those  in  childbed,  which  was  a  complete  and 
methodic  collection  of  the  observations  derived  from  those  who  had  pre- 
ceded him,  with  those  which  his  own  extended  practice  had  furnished. 
The  first  edition  of  this  work  appeared  in  1GG8.  It  was  translated 
into  nearly  all  the  languages  of  Europe,  and  powerfully  contributed  to 
vulgarise  sound  obstetrical  doctrines.  The  way  once  opened,  a  crowd  of 
competitors  came  forth,  and  by  their  labors  enlarged  it  very  much.  In 
that  number  we  particularly  distinguish  Paul  Portal,  Deventer,  Pen, 
Amand,  and  Delamotte,  who  were  cotemporaries,  and  formed  the  transi- 
tion from  the  seventeenth  to  the  eighteenth  centuries. 

*  Observations  diverses  sur  la  Sterility,  Perte  de  Fruit,  Fe'condite',  Accouchement, 
et  Maladies  des  Femmes,  et  Eufants  nouveau — ne's.     Paris,  1G09  or  1626. 

•(■  We  will  mention,  also,  as  forming  an  exception  to  the  common  rule  in  these 
latter  times,  two  women,  whose  -works  are  marked  by  sound  observations:  Madame 
Lachapelle,  sage-femme  in  chief  of  the  Maison  d' Accouchement  of  Paris  [Pra- 
tisqne  des  Accoiichemmts,  Paris,  1825;)  Madame  Boivin,  sage-femme  in  chief  of  the 
Maison  Royale  de  Sante.  [Memorial  de  Part  des  Accouehements,  Paris  183G,  4th  Ed. 
Trait e  des  Maladies  de  VUteru,s,  Paris,  1833). 


OBSTETRICS.  463 

About  this  time,  the  Chamberlaius,  a  family  of  English  practitionei's, 
who  devoted  themselves  exclusively  to  the  practice  of  accouchements, 
invented  an  instrument  to  facilitate  the  extraction  of  the  head,  when  it 
was  arrested  in  its  passage.  One  of  them,  Hughes,  came  to  Paris  to 
try  his  instrument,  but  not  succeeding  in  a  difficult  case,  he  passed  on 
to  Holland,  where  he  obtained  more  success.  Two  accoucheurs  of  that 
country,  Eoonhuyson  and  Euysch,  bought  his  secret,  which  they  kept 
too  faithfully  for  the  sake  of  their  own  memory  and  humanity.  But  in 
1721,  a  surgeon  of  Gand,  named  John  Palfyn,  in  seeking  to  discover 
the  secret  of  the  Chamberlains,  conceived  the  idea  of  contriving  a  tire- 
tete  (literally,  a  head-drawer,)  composed  of  two  steel  spoons.  He 
hastened  to  publish  it,  and  merits,  by  this  very  praiseworthy  act,  the 
title  of  first  inventor  of  the  forceps.  His  tire-tete,  advantageously 
modified  by  Smellie,  of  England,  and  Levret,  of  France,  has  taken  rank 
under  the  name  of  forceps,  among  the  most  useful  discoveries  of  modern 
surgery.  It  has  rendered  much  less  frequeat  the  emj^loymeut  of  crochets, 
and  murderous  instruments,  and  although  it  has  not  come  into  common 
use,  only  within  a  hundred  years,  we  can  say,  without  exageration,  that 
it  has  already  saved  the  lives  of  a  multitude  of  women  and  children. 

During  the  eighteenth  century  obstetrics  advanced  in  several  respects 
to  a  degree  of  perfection  similar  to  that  of  the  exact  sciences,  by  the  con- 
course of  a  great  number  of  distinguished  surgeons,  who  occupied  them- 
selves in  its  study,  in  a  special  manner.  It  is  impossible  to  mention 
here  the  names  and  titles  of  all  those  who  rendered  some  service  to  this 
branch  of  art;  we  shall  mention  in  first  rank,  Levret  and  Smellie  ;  then, 
Puzos,  Burton,  Ptoederer,  Denman,  Stein,  Deleurye,  Saxtorph,  Solayres, 
and  his  disciple  J.  L.  Baudelocque,  the  most  celebrated  among  the 
last  mentioned.'-'     While  the  art  became  more  perfect,  establishments 

*  Baudelocque  was  not  only  the  most  renowned  accoucheur  of  the  close  of  the 
last  century  ;  but  he  recommends  himself  to  us,  also,  by  his  grateful  recognition 
of  the  instruction  received  from  his  medical  preceptor,  as  follows  :  "  if  a  large 
number  of  men,  in  perpetuating  by  their  writings  the  art  of  Midwifery,  have 
rendered  great  services  to  the  race,  there  is  also  a  large  number  of  others  whose 
knowledge,  so  to  say,  has  been  buried  with  them,  and  to  whom  society  -would 
have  been  no  less  indebted,  if  their  incessant  labors  or  premature  death,  had  not 
prevented  them  from  publishing  the  fruit  of  their  toil  and  experience.  There  is 
one  of  these  latter,  of  whom  the  recollection  will  perpetuate  unceasingly  our 
regrets,  and  to  whose  memory  we  shall  always  pay  with  pleasure  the  tribute  of 
gratitude  we  justly  owe  him  :  I  mean  Solayres.  It  is  less  the  man,  whom  we 
esteemed,  and  whose  death  we  regret,  than  the  loss  of  that  profound  knowledge 
of  the  art  which  he  cultivated,  and  which  he  taught  among  us  with  the  greatest 
distinction.  What  I  have  been  able  to  collect  of  his  doctrines,  will  not  compen- 
sate for  his  loss,  because  a  man  cannot  transmit  his  genius  with  the  knowledge 
he  had  acquired."    L'Art  des  Accouchements,  p.  10.     3d  edit.  1796. 


464  REFORM   PERIOD. 

destined  to  propagate  its  lights  and  benefits,  were  multiplied.  There 
were  erected  in  all  the  capitals  of  Europe,  and  in  other  cities,  practical 
schools  of  accouchements,  where  a  crowd  of  pupils  of  both  sexes  entered, 
to  receive  from  skilful  masters  sound  obstetrical  doctrines.  These 
young  accoucheurs — these  new  sage  femmes — spread  afterwards  in 
the  most  remote  provinces  the  excellent  precepts  which  they  had 
acquired,  and  combatted  with  success  the  time-honored  prejudices  of 
ignorance. 

To  better  appreciate  the  progress  effected  in  obsti-etrical  science 
during  the  Reformative  Period,  we  will  examine  successively  some  of  the 
capital  points  of  the  science. 

PREGNANCY. 

In  order  to  recognize  a  state  of  pregnancy,  the  ancients  had  admitted 
a  mass  of  insignificant  signs  and  ridiculous  practices,  in  the  midst  of 
which  we  find  symptoms  of  a  real  value,  such  as  the  augmentation  of  the 
volume  of  the  uterus,  the  movements  realized  by  women,  in  the  womb, 
the  cessation  of  the  menses,  the  developement  of  the  mammae,  and  the 
secretion  of  the  milk.  This  collection  of  signs  constitutes,  doubtless, 
a  strong  presumption  of  pregnancy,  if  not  a  certainty :  but  it  is  rare  to 
find  them  all  associated  in  the  same  person,  so  that  in  the  greater  number 
of  cases,  the  ancients  could  only  arrive  at  a  probability,  more  or  less 
great.  Moderns  have  added  to  the  preceding  symptoms,  other  signs, 
by  means  of  which  we  may  reach  much  sooner,  and  more  certainly,  the 
recognition  of  the  state  of  pregnancy :  these  signs  are,  first,  those  ob- 
tained by  the  vaginal  touch,  which  have  a  great  value  ;  secondly, 
those  furnished  by  auscultation,  which  has  been  recently  applied  to 
this  subject. 

NATURAL  LABOK. 

The  ancients  were  entirely  ignorant  of  the  relation  that  must  exist 
between  the  dimensions  of  the  head  of  the  infant,  and  the  pelvis  of  the 
mother,  so  that  the  labor  might  terminate  by  the  sole  forces  of  nature  ; 
neither  had  they  any  but  false  and  vague  ideas  on  the  mechanism  of  this 
function,  and  the  true  agencies  that  concur  to  effect  it.  They  believed 
for  example,  that  the  expulsion  of  the  fetus  was  due  to  its  own  efforts, 
which  it  made  in  order  to  get  clear  of  its  envelopes :  while  it  is  now 
well  known  that  in  the  act  of  parturition  the  fetus  is  entirely  passive, 
and  that  its  expulsion  from  the  womb  of  its  mother  is  determined 
principally,  by  the  contractive  action  of  the  uterus  and  abdominal 
muscles.  The  ancients  also  imagined  that  the  head  engages  in  the 
pelvis  in  a  transverse  position :  when  the  most  simple  inspection  of  the 
parts  suffices  to  show  that  this  is  not  the  case.  In  fact  it  is  necessary 
that  the  head,  as  it  advances  in  the  pelvic  excavation,  execute  a  spiral 


OBSTETRICS.  465 

movement  of  nearly  a  quarter  of  a  circle,  so  that  its  smaller  diameters 
shall  constantly  correspond  to  the  least  ones  of  the  osteo-membranous 
canal.  The  knowledge  of  these  particulars,  and  a  multitude  of  others, 
is  not,  as  may  be  supposed  by  those  who  are  strangers  to  the  art  of 
accouchements,  a  pure  speculative  knowledge ;  so  far  from  it,  it  is  on  the 
contrary  an  indispensable  knowledge,  to  enable  the  accoucheur  to  keep 
himself  unceasingly  acquainted  with  the  progress  of  the  parturition ; 
that  he  may  be  able  at  each  phase  of  labor  to  appreciate  with  exactness 
the  nature  of  the  obstacles  which  retard  or  arrest  the  accomplishment 
of  this  function. 

DIFFICULT  LASOB. 

The  death  of  the  infant  in  the  womb  of  its  mother,  or  its  extreme 
feebleness,  constituted,  in  the  eyes  of  the  ancients,  a  very  grave  acci- 
dent, which  they  regarded  as  an  insurmountable  obstacle  to  the  natural 
termination  of  the  accouchement,  as  the  result  of  the  opinion  they 
entertained,  that  parturition  depended  on  the  efforts  of  the  fetus. 
Consequently,  they  did  not  hesitate,  in  this  juncture,  to  employ  crotchets 
to  extract  the  infant,  an  operation  always  fatal  to  it,  in  case  it  still 
retains  vital  manifestations,  and  which  is  not  without  danger  to  the 
mother.  Experience,  and  a  better  theory  of  the  mechanism  of  partu- 
rition, have  demonstrated  that  the  death  of  the  fetus  opposes  no  great 
obstacle  to  the  accomplisliment  of  this  act — that  it  obstructs  it  only  a 
little,  and  this  circumstance  by  itself  could  never  justify  the  employ- 
ment of  murderous  instruments. 

Hippocrates  considered  the  presentation  of  the  feet,  also,  as  excess- 
ively dangerous,  and  he  advised  recourse,  in  such  a  case,  to  various 
maneuvers  which  would  have  a  tendency  to  bring  the  head  again  to 
the  straight — maneuvers  nearly  always  fruitless,  and  very  often  injuri- 
ous. Moschion,  a  celebrated  accoucheur  of  the  second  century  of  the 
Christian  era,  Celsus,  and  Paul  of  iEgina;,  appreciated  better  the  incon- 
vencies  of  this  position  ;  they  regarded  it,  truly,  as  much  less  advantageous 
than  that  of  the  head,  but  not  as  opposing  an  insurmountable  obstacle 
to  the  spontaneous  termination  of  the  accouchement.  In  the  presenta- 
tions of  the  shoulder,  and  other  parts  of  the  trunk,  the  same  accouch- 
eurs established  the  principle,  that  it  was  necessary,  in  the  first  place, 
to  endeavor  to  bring  the  head  to  the  passage,  and  if  that  could 
not  be  done,  to  search  for  the  feet,  and  take  away  the  fetus  by  that 
extremity.-- 

*Paul.  JEgin.,  lib.  iii,  cap.  Lxxvr.— Aeteus,  Tetr.  IV,  serm.  4,  cap.  xxni. — Gels. 
lib.  VII,  cap.  XXIX. 


466  REFORM   PERIOD, 

The  moderns,  fiucling  that  the  efforts  made  with  the  view  of  bringing 
the  head  again  to  the  straight,  are  scarcely  ever  successful,  and  that 
they  were  not  without  danger,  both  to  the  mother  and  the  fetus,  have 
given  the  formal  precept  to  get  hold  of  the  feet  in  all  the  presentations 
of  the  trunk,  and  terminate  the  accouchement  by  the  hand.  They  pre- 
scribe the  same  plan  whenever  a  hemorrhage  or  convulsions  impose  the 
necessity  of  hastening  the  labor. 

When  the  head,  engaged  in  the  excavation  of  the  pelvis,  no  longer 
advances  or  recedes,  on  account  of  the  inertia  of  the  uterus,  or  the  gen- 
eral exhaustion  of  the  forces  of  the  mother,  the  forceps  now  offers  a 
precious  means  for  her  delivery,  without  compromising  the  life  of  the 
child ;  while,  before  the  invention  of  that  instrument,  the  accoucheur 
was  compelled  to  pierce  the  cranium,  and  afterward  make  extraction 
with  a  crotchet.  Eecourse,  however,  in  such  a  case,  could  be  had  to 
symphyseotomy,  if  the  narrowness  of  the  inferior  straight  would  not 
permit  to  act  efficaciously  with  the  forceps. 

Lastly,  though  the  Cesarian  operation  had  been  known  from  the 
remotest  antiquity,  it  does  not  appear  that  it  was  practiced  on  the  liv- 
ing, in  the  earliest  times.  It  was  an  extreme  resource,  which  was  only 
resorted  to  on  women  who  died  in  the  act  of  labor ;  in  fact,  a  Eoman 
law,  attributed  to  Numa  Pompilius  {lex  regia,)  prescribed  that  all 
women  should  be  opened  who  died  while  pregnant,  so  as  to  save  the 
infant  if  possible.  The  first  authentic  example  of  hj'sterotomy  execu- 
ted on  a  living  woman  does  not  go  fui'ther  back  than  the  fifteenth  cen- 
tury of  our  era,  as  we  have  before  remarked.  When  a  vice  of 
malformation  of  the  pelvis,  or  an  extraordinary  volume  in  the  fetus, 
rendered  its  passage  impossible  through  the  natural  passages,  the 
ancients  knew  no  other  expedient  than  to  cut  the  infant  in  pieces  in 
the  womb  of  its  mother,  and  withdraw  it  in  sections.  The  moderns 
have  dared,  in  such  cases,  to  attempt  the  Cesarian  operation,  and  have 
sometimes  succeeded  in  saving  the  lives  of  both  mother  and  child." 

THE   PLACENTA. 

The  Asclepiadge  had  very  well  felt  the  importance  of  this  last  period 
of  the  accouchement;  their  books  allude  to  it  in  more  than  one  place, 
but  in  the  midst  of  a  crowd  of  useless  or  odd  remedies,  which  they 
recommend  as  proper  to  procure  the  evacuation  of  the  after-birth ;  the 
following  proceeding  only,  is  worthy  of  notice.     Place,  they  say,  the 

"  See  observations  of  MM.  Professors  Stoltz,  (Memoires  de  I'Acade'uiic  Eoyale 
de  Me'dicine.  Paris,  1836)  ;  P.  Dubois,  (Bull,  de  I'Academie  Royale  de  Me'dicine, 
vol.  Ill,  p.  G91,  vol.  V.  p.  2o.) 


LEGAL    MEDICINE.  467 

woman  on  a  chair  witli  a  liole  in  it,  or  if  slie  is  too  feeble,  lay  her  in 
a  bed  very  much  inclined :  then  place  the  child,  which  is  still  connected 
with  the  umbilical  cord,  on  recently  carded  and  very  soft  wool,  so  that 
its  weight  shall  draw  gently,  and  without  a  jerk ;  or  better  still,  have 
two  leather  bottles  full  of  water,  tied  together,  cover  them  with  wool, 
and  lay  the  child  upon  them ;  then  pierce  each  with  a  small  instru- 
ment, so  that  the  water  shall  slowly  run  out,  and  the  weight  of  the 
child  be  thus  gradually  made  to  draw  upon  the  after-birth/-' 

Celsus,  to  fulfil  the  same  indication,  gives  much  more  simple  and 
rational  directions.  "  The  physician,"  he  says,  "  should  give  the  infant 
in  charge  of  an  assistant ;  then  he  should  make  moderate  traction  on  the 
umbilical  cord,  with  the  left  hand,  so  as  not  to  break  it.  If  that  does 
not  suffice,  he  must  carry  the  right  hand  along  the  iimbilical  cord  to 
the  after-birth,  detach  the  vascular  and  membranous  connections  which 
unite  it  to  the  body  of  the  womb,  and  then  withdraw  it  entire,  as  well 
as  the  clots  of  blood  which  may  have  accumulated  in  the  uterine  cavity."  f 

The  accoucheurs  who  followed  Celsus  have  all  repeated  the  precept 
which  we  have  just  transcribed  ;  but  the  moderns  only  have  completed 
it,  in  pointing  out  the  cases  in  which  it  is  necessary  to  hasten  the  deliv- 
ery of  the  after-birth,  and  those  where  it  is  proper  to  delay ;  and  in 
indicating  the  course  to  be  pursued  when  there  is  an  hour-glass  con- 
traction, or  the  umbilical  cord  is  ruptured. 


CHAPTER    VIII. 

LEGAL  MEDICINE. 

If,  with  Fodere,  legal  Medicine  be  defined,  the  rational  application  of 
all  physical,  natural,  and  medical  knowledge,  to  the  execution  of  the 
laws,  and  the  conservation  of  public  health,  there  is  no  doubt  but  that 
the  history  of  the  ancients  would  ofi'er  us  numerous  examples  of  this 
species  of  Medicine,  We  have  already  signalized  remarkable  examples 
of  it  in  the  legislation  of  the  Egyptians,  the  Hebrews,  and  other  cele- 
brated nations  of  anticjuity.  The  old  lioman  laws,  attributed  to  Xuma 
Pompilius,  and  designated  by  the  title.  Leges  Regice,  contained  also  a 
very  judicious  application  of  the  physical  knowledge  of  the  times,  in 

~  Traitc  de  la  Superfetation.  Also,  De  la  Nature  de  la  Ferume.  Maladies  des 
Femmes. 

t  Lib.  II.,  cap.  XXIX. 


468  REFORM    PERIOD. 

several  of  tlicir  cuactments  relative  to  testaments,  to  the  separation  of 
the  spouse,  to  the  nullity  of  marriages,  to  abortion,  to  the  presumption 
of  survivorship,  etc.  But  it  seems  to  me  that  such  a  definition  embraces 
too  many  objects,  and  that  medical  science,  considered,  as  has  just  been 
said,  in  all  the  application  that  can  be  made  of  it,  by  governments,  to 
the  public  health,  has  been  better  denominated  by  recent  vrriters, 
political  Medicine.  Consequently,  we  shall  define  legal  Medicine,  with 
some  jurist  physicians  of  great  reputation,  the  xoliole  of  medical  and  phy- 
sical knowledge  proiyer  to  enlighten  magistrates  in  the  administration  of 
justice.'-' 

The  custom  of  summoning  physicians  into  the  sanctuary  of  justice,  to 
enlighten  the  magistrate  on  certain  questions  which  require  special  no- 
tions in  physics  and  in  medicine,  does  not  go  back  to  a  very  ancient 
epoch.  I'odere,  from  whom  we  borrow  nearly  all  the  substance  of  this 
cbapter,  says  that  it  commenced  under  the  first  Christian  emperors,  and 
that  it  owes  its  origin  to  ecclesiastical  authority.  Charlemagne  con- 
firmed afterwards  what  Justinian  had  prescribed.  He  ordered,  in  his 
Capitularies,  that  in  the  questions  that  pertain  to  man,  the  jvdges  shall 
support  themselves  on  the  advice  of  physicians,  and  that  tlie  visits,  as 
well  as  the  reports,  be  made  by  men  recognized  as  masters  in  the  Art.  and 
of  hi g] I  moral  character,  by  intelligent  jurors  acquainted  xoith  matters 
belonging  to  the  case.  The  tribunal  of  Chatelet  appears  to  have  been 
the  first  which  comprehended  the  utility  of  consulting  with  expert  phy- 
sicians, whose  knowledge  they  could  invoke  whenever  they  felt  its  need. 
An  edict  of  Philippe  le  Bel,  of  1311,  qualified  Master  John  Potard  with 
the  title  of  sworn  surgeon  of  Chatelet. 

Nevertheless,  legal  medicine  was  not  yet,  at  that  epoch,  but  in  a 
rudimentary  state.  It  was  composed  only  of  a  small  number  of  princi- 
ples, disseminated  in  the  general  treatises  of  medicine  or  surgery,  and 
obscured  by  many  prejudices.  There  were  connected  with  the  tribunals 
sworn  sage  femmes,  as  well  as  sworn  physicians.  Laurent  Joubert  cites, 
in  his  Recuil  des  Erreurs  Poptdaires,  three  reports  of  sage  femmes,  rela- 
tive to  accusations  of  violation  and  defloration.  The  reports — one  pre- 
pai*ed  at  Paris,  another  at  Beam,  the  third  at  Carcassone — agree  among 
themselves  in  pointing  out  certain  lesions,  as  indicating  violent  attempts 
upon  chastity.  The  author  concludes  that  the  opinions  of  the  experts  of 
his  time  was  unanimous  on  these  points ;  but  he  does  not  hesitate  to 
combat  that  opinion  in  discussing   in  succession  the  pretended  signs 

"  See  Prunelle's  Discourse  before  the  Faculty  at  Montpelier,  1811 ;  OrfiUa,  Lefons 
de  Me'decine  Le'gale,  t.  I.,  lee.  i.  Diet,  de  Medecine.,  in  21  vols.,  art.  Me'decine 
Politique. 


LEGAL   MEDICINE.  469 

alleged  in  the  reports,  and  he  demonstrates,  from  the  most  respectable 
authorities  in  Medicine,  that  they  are  superficial  or  false.  The  follow- 
ing is  one  of  the  reports  alluded  to,  by  which  we  may  judge  of  the  value 
of  the  others.  ■•' 

The  constitution  published  by  the  Emperor  Charles  Y.,  in  1552,  gave 
great  importance  to  Legal  Medifine,  by  extending,  and  determining 
much  better  than  had  been  done  before,  its  attributes ;  that  legislator, 
treated,  in  detail,  questions  of  infanticide,  wounds,  poisoning,  abortion, 
and  he  mentions  the  means  proper  to  be  employed,  to  establish  these 
sorts  of  crimes.  He  requested  that  medical  men  commence  to  establish, 
in  a  positive  manner,  what  was  the  sum  of  the  offense ;  and  he 
traced  the  rules  for  drawing  up  reports  of  cases  tried  in  the  courts. 
The  one  hundred  and  forty-seventh  article  of  that  constitution  pre- 
scribes a  public  examination  when  a  questionable  hurt  is  followed  by 
death,  if  the  death  was  really  the  necessary  effect  of  the  wound  ;  or, 
if  it  proceeded  from  some  other  cause,  as,  for  instance,  negligence,  or 
bad  treatment,  etc.  Several  ordinances  of  the  Kings  of  France  contain 
analagous  sections  ;  notably,  that  of  Henry  III,  dated  1570. 

At  the  beginning  of  the  seventeenth  century,  Fortunatus  Fidelis, 
having  drawn  together  all  that  had  been  written  on  this  matter,  pub- 
lished the  first  special  treatise  on  Legal  Medicine.  From  .that  time 
this  branch  of  science  had  a  separate  and  distinct  existence,  and 
rapidly  increased.  Paul  Zacchias,  physician  to  Pope  Innocent  X., 
contributed  very  much  to  its  extension,  by  making  public  his  Medico- 
legal questions,  which  enjoyed,  for  more  than  a  half  century,  a  universal 
reputation,  and  still  preserve,  notwithstanding  the  incessant  progress 
of  physico-natural  sciences,  a  part  of  their  intercst.f 

'- "  Nous  Marion  Teste,  Jane  de  Meaux,  Jane  de  la  Guigans,  et  Magdeleine  de  la 
Lippue,  matrones  jure'es  de  la  ville  de  Paris,  certifions  a  tous  qii'il  appartiendra 
que,  le  lie  jour  de  juin  lo32,  par  orJonnance  de  M.  le  prc'vost  de  Paris,  ou  son 
lieutenant  en  ladite  ville,  nous  somnies  transporte'es  en  la  rue  de  Fre'paut,  oii 
pend  pour  enseigne  la  Pantoufle,  ou  nous  avons  vu  et  visite  Henriette  Peliciere, 
jeune  fille  de  quinze  ans  ou  environ,  sur  la  plainte  par  elle  faite  a  justice,  contre 
Simon  le  Bragard,  duquel  elle  a  dit  avoir  ete  force'e  et  defloree.  Le  tout  vu  et 
visite  au  doigt  et  a  I'oeil,  nous  trouvons  qu'elle  a :  1.  les  barres  froissees,  2.  le 
baleron  demis,  3.  la  dame  du  milieu  retire'e,  4.  le  ponnant  deTaiflFe',  5.  les  toutons 
devoyes,  G.  I'enchenart  re'tourne',  7.  la  babolle  abattue,  8.  I'entrepont  ride,  9. 1'ar- 
riere-fosse  ouverte,  10.  le  guilloquet  fendu,  11.  le  lippon  recoquillc,  12.  le  barbi- 
dant  tout  e'corche',  13.  tout  le  lipandis  pele',  l-t.  le  quillevard  elargi,  les  balunans 
pendans:  le  tout  vu  et  visite  feuillet  par  feuillet,  avons  trouve'  qu'il  y  avait  trace 
de  v..  Ainsi  nous  dites  matrones,  certifions  etre  vrai,  a  vous,  M.  le  prevost,  au 
serment  qu'avons  a  ladite  ville."     (Ire  partie,  liv.  v.  chap,  iv.) 

t  Qu;estiones  medico-legales.  Ire  Ed.,  Amsterdam,  1651.  This  work  had  a 
great  numb2r  of  Editions. 


470  REFORM    PERIOD. 

Legal  Medicine  does  not  constitute,  rigorously  speaking,  a  particular 
branch  of  science ;  it  is  nothing  else  than  the  special  application  of  the 
light  furnished  by  it,  to  the  clearing  up  of  certain  judicial  questions. 
But  this  special  application  requires  to  be  well  directed,  a  tact  and 
skill  -which  all  practitioners  cannot  possibly  acquire ;  and,  even  a 
knowledge  of  laws,  to  which  they  are  often  strangers.  On  that  account, 
several  ,Kings  of  France,  Henry  IV,  and  Louis  XIY.  among  others, 
established,  in  all  the  communes  and  principal  cities,  royal  sworn  physi- 
cians, charged  to  make  the  report  in  legal  trials.  "  This  establishment," 
says  Fodere,  "  did  not  do  all  the  good  that  it  promised,  because  it  was 
stricken,  from  its  birth,  with  a  mortal  disease,  the  venality  of  officers !" 
Nevertheless,  this  philosophic  writer  does  not  hesitate  to  express  a 
desire  to  see  re-established  in  our  days,  a  similar  institution ;  but,  free 
from  the  original  vice  that  reproached  it. 

Among  the  legal  physicians  of  the  eighteenth  century,  whose  writings 
have  contributed  most  to  advance  science.  I  will  particularly  mention 
John  Bohn,  professor  at  Leipsic ;  Michael-Bernard  Valentin,  professor  in 
the  University  at  Halle,  and  one  of  the  most  distinguished  sectators  of 
Stahlism  ;  Herman  Frederic  Teichmeyer,  professor  in  the  LTniversity  at 
Jena,  who  had  A.  Haller  for  a  pupil  and  a  son-in-law ;  Oliver  Mahon, 
professor  in  the  School  of  Paris  ;  John  Daniel  Metzger,  professor  in  the 
University  at  Koenigsburgh,  J.  P.  Frank,  and  many  others ;  but,  above 
all,  the  Savan  from  whom  we  have  borrowed  the  greater  part  of  the 
ideas  emitted  in  this  chapter. 


CHAPTER     IX. 

CLINICS. 

We  have  heretofore  said,  that  two  modes  of  clinical  instruction  may 
be  pointed  out,  namely,  oral  and  written.  In  the  first,  the  patients  are 
put  under  the  observation  of  the  students,  who  observe,  for  themselves, 
the  symptoms,  the  course  and  termination  of  the  diseases,  as  well  as  the 
effect  of  the  remedies  prescribed  by  the  professor.  This  is  clinical 
instruction  properly  said,  such  as  was  practiced  in  the  sacerdotal 
families  of  Egypt  and  Greece,  who  were  devoted  to  the  worship  of 
Esculapius  and  such  as  it  exists  now,  in  all  the  faculties  and  schools  of 
Medicine.  The  second  method  of  clinical  instruction  consists  in  the 
observation,  or  the  histories  of  diseases,  gathered  at  the  bed-side  of  the 


CLINICS.  471 

sick,  witli  all  the  details  of  treatment,  and  published  afterward, 
both  for  the  instruction  of  pupils  and  the  advancement  of  science. 
These  kind  of  clinical  repertories  are,  indeed,  of  great  utility.  The 
nosologist  may,  and  must  draw  from  them  the  natural  characters  of  the 
morbid  species  he  describes ;  the  therapeutist  finds  there,  also,  models 
of  treatment  for  each  disease,  which  enables  him  to  deduce  the  general 
and  particular  rules  of  his  art.  Thus  the  facts  of  daily  practice, 
observed  with  attention,  and  traced  with  fidelity,  serve  to  constitute 
and  develope  science:  science,  in  its  turn,  presents,  in  abridged  for- 
mula?, the  summary  of  the  experience  of  all  ages — directs  the  prac- 
titioner with  greatest  certainty,  from  day  to  day — spares  him  infinite 
gropings,  and  deplorable  errors. 


§1.  Or.\l  Clinical  Teaching. 
We  have  alread}'  stated  why  this  mode  of  instruction,  the  most  effica- 
cious of  all,  and  the  best  to  form  excellent  practitioners,  was  maintained  in 
the  Asclepidean  families,  particularly  in  that  of  Cos,  till  the  foundation 
of  the  school  at  Alexandria,  and  why  it  was  afterward  abandoned,  to  be 
revived  only  at  an  epoch  very  close  to  our  own.  Some  crudites  have 
thought  that  they  have  discovered  traces  of  cliuical  teaching  in  the 
histories  of  the  Arabian  Universities,  and  cite,  in  support  of  this  opin- 
ion, a  passage  of  Ali-Abbas,  in  which  that  author  assumes  to  have  col- 
lected at  the  bedside  the  most  of  the  descriptions  of  diseases  which  he 
reports  ;  and  in  another  passage,  where  he  recommends  young  physicians 
to  frec[uent  the  hospitals.  But  the  presence  of  a  few  pu2)ils  during  the 
visitations  and  consultations  of  the  physicians  of  a  hospital,  constitutes 
no  more  clinical  teaching,  than  the  practice  adopted  by  some  practi- 
tioners of  antique  Eome,  to  train  after  them  in  the  streets,  and  in  the 
houses  of  their  clients,  a  group  of  men  of  every  class,  whom  they  deco- 
rated with  the  title  of  disciples. 

The  first  essay  in  clinical  teaching,  of  which  the  historj^  of  medicine 
makes  mention,  since  the  dissolution  of  the  Asclepidean  schools, 
occurred  in  1578,  at  the  hospital  of  St.  Francis,  in  Padua.  The  pro- 
fessors, Albert  Bottoni  and  Mark  Oddo,  had  charge  of  it :  one  had  the 
female,  the  other  the  male  ward."  We  are  ignorant  whether  this  mode 
of  instruction  was  continued,  after  them,  but  we  are  led  to  think  it  was 
discontinued,  from  the  fact  that  none  are  named  as  their  immediate 
successors.  About  the  commencement  of  the  seventeenth  century.  Otto 
de  Heurn,  professor  of  practical  medicine  in  the  Universit3^  of  Leyden, 
introduced  the  practice  of  giving  bedside  instruction.     Francis  of  Lebo, 

*  Comparetti  Saggio  dclla  Scuola  Cliiiica  nello  spedale  di  Padova.  p.  6.  Thoma- 
8iu8,  DeGymnasio  Patorino,  lib.  iv.,  p.  420. 


472  REFORM   PERIOD. 

called  Silvius,  who  succeeded  him,  adopted  the  same  plan ;  his  clinical 
lessons  had  great  reiiute,  and  drew  a  numerous  concourse  of  auditors 
from  the  year  1658  to  1672,  which  has  caused  him  to  be  regarded  as 
the  founder  or  restorer  of  this  mode  of  teaching. 

Notwithstanding  the  eclat  of  this  innovation,  and  its  well  recognised 
utility,  the  successors  of  Sylvius  let  it  fall  into  disuse.  Clinical  instruc- 
tion ceased  to  exist  for  more  than  forty  years,  till  the  epoch  when  Her- 
mann Boerhaave,  already  invested  with  several  functions  in  the  Uni- 
versity of  Leyden,  was  charged  also  with  the  duties  of  the  chair  of 
practical  medicine.  The  illustrious  professor  conceived  at  once  what 
advantage  must  accrue  to  the  students,  if  the  teacher  made  an  applica- 
tion, in  their  presence,  of  the  principles  he  had  inculcated.  Though 
the  hospital  at  Leyden  offered  few  resources  for  clinical  teaching,  on 
account  of  the  small  numher  of  beds  it  contained,  Boerhaave  made  such 
good  use  of  them,  that  very  soon  auditors  came  to  his  course  from  all 
parts  of  Europe.  His  renown,  which  was  already  great,  for  he  had  pub- 
lished his  two  principal  works,  the  Institutes,  and  Aphorisms,  became 
immense.  Persons  came  to  consult  him,  from  the  most  distant  countries. 
He  was  in  correspondence  with  several  sovereigns,  and  even  with  the 
Pope,  though  he  was  a  Protestant.  Finally,  he  received,  on  a  memo- 
rable occasion,  a  very  touching  testimonial  of  the  regard  of  his  fellow- 
citizens.  A  disease  having  forced  him  to  interrrupt  his  teaching  for 
six  months,  the  first  day  of  his  convalescence  was  celebrated  by  a  gene- 
ral and  spontaneous  illumination. 

Now,  if  we  seek  to  ascertain  the  real  merits  that  recommend  this  illus- 
trious man  to  the  admiration  of  posterity,  we  shall  find  them  clearly 
deduced  in  the  following  passage  from  one  of  his  biographers.  "  Boer- 
haave," he  says,  "  exercised  during  his  life,  and  long  afterward,  an 
immense  influence  in  medicine.  Inferior  in  genius  to  his  cotemporaries, 
Frederick  Hoffman  and  Stahl,  he  had  a  reputation  more  universally  dif- 
fused, and  his  doctrines  have  long  prevailed  over  those  of  his  rivals. 
He  owed  this  advantage  to  the  eclat  of  his  teachings,  and  the  brilliant 
qualities  of  his  mind.  Endowed  with  activity  and  rare  facility,  he 
acquired  the  most  varied  and  extended  knowledge.  He  formed  from 
this  a  system,  united  in  all  its  parts  with  infinite  art ;  presented  in  his 
lectures  and  in  his  works  with  method,  clearness,  precision,  and  embel- 
lished with  an  uncommon  grace  of  elocution,  it  acquired,  as  may  easily 
be  conceived,  universal  commendation.  This  system,  which  may  be 
considered  as  a  veritable  Eclecticism,  is  made  up  of  some  ideas  of  Them- 
ison  and  the  ancient  Methodists,  of  those  of  the  medico-chemist  Lebo, 
and  especially  of  the  mechanical  theories  of  the  iatro-mathomaticians, 
toward  whom  his  taste,  and  his  studies  in  the  mathematical  sciences, 


CLINICS.  473 

naturally  carried  him.  The  latter  theories  arc  predominant,  which  have 
justly  caused  Boerhaave  to  be  ranked  among  mechanic  physicians.  It 
is  to  be  regretted  that  with  such  happy  faculties  for  observation,  Boer- 
haave allows  himself  to  be  drawn,  against  his  principles  even,  into  the 
vortex  of  systems  and  hypotheses.  He  commences  by  preaching,  enthu- 
siastically, the  method  of  Hippocrates,  and  ends  hy  following  the  bril- 
liant but  unsafe  example  of  Galen."-' 

The  prodigious  success  of  the  clinic  at  Leyden,  was  decisive  in  favor  of 
that  mode  of  teaching.  From  the  following  year,  1715,  the  sovereign  pon- 
tiff established,  at  Eome,  a  similar  institution,  directed  by  the  cele- 
brated Lancisi.  Soon,  Edinburgh,  in  Scotland,  Vienna,  in  Austria, 
Pavia,  and  other  cities  in  Italy,  as  well  as  in  England  and  Germany, 
were  endowed  with  clinical  chairs.  France  followed  a  little  later  these 
examples.  In  1795,  was  established,  at  Paris,  the  first  chair  of  clinical 
medicine  which  the  school  of  that  city  ever  possessed.  Corvisart,  who 
occupied  it  at  first,  with  J.  J.  Leroux,  elevated  his  teaching  to  a  level 
with  those  of  the  highest  reputation.  In  fine,  the  close  of  the  eighteenth 
century  saw  clinical  instruction  established  in  all  the  schools  of  Europe, 
and  even  in  some  of  those  of  the  New  World. 

After  the  death  of  Boerhaave,  the  faculty  of  Leyden,  which  had  been 
elevated  to  the  highest  degree  of  splendor,  rapidly  declined.  That  of 
Edinburgh,  and  above  all,  that  of  Vienna,  occupied  thereafter  the  first 
rank,  and  so  existed,  without  rivals,  during  more  than  half  a  century. 
The  clinical  chair  of  Vienna,  founded  in  1733,  by  Van  Swieten,  under 
the  auspices  of  the  Empress  Maria  Theresa,  was  occupied  successively 
by  Anthony  de  Haen,  Maximillian  Stoll,  and  John  Peter  Frank,  who 
still  occupied  it  at  the  commencement  of  the  present  century,  after 
having  been  one  of  the  glories  of  the  school  of  Pavia.  Thus,  after  an 
interruption  of  more  than  two  thousand  years,  clinical  teaching  was 
revive  1  more  brilliant  than  it  ever  had  been.j 

'^'  Diet.  Hist,  de  Med.  by  M.  Dezeimeris,  art.  Boerhaave. 

fWe  have  sketched  in  this  section  the  history  of  public  and  official  clinical 
instruction.  As  to  private  and  free  instruction,  everything  leads  us  to  believe 
that  it  never  entirely  ceased;  but  it  can  not  be  traced  with  certainty.  It  is  more 
than  probable  that  in  all  time,  physicians  attached  one  or  more  young  men  to 
their  business,  who  accompanied  them  in  their  visits,  both  in  private  and  hospital 
practice,  whom  they  trained  in  the  healing  art,  both  by  their  example  and  their 
counsels.  In  this  way  the  popular  archiaters,  created  by  the  edict  of  the  Emperor 
of  Rome,  were  charged  to  instruct  and  examine  the  aspirants  to  the  practice  of 
medicine.  In  this  way  also  were  instituted  temporarily,  several  clinics  in  Persia 
and  other  countries  under  Arab  dominion,  and  so,  also,  in  1780,  L.  Desbois  de 
Rochefort  (born  in  Paris,  October  9, 17.50,  died  26th  of  January,  1786),  gave  at 
La  Charite  Hospital,  Paris,  clinical  medical  instruction,  which  attracted  anumer. 
ous  assemblage  of  auditors. 

30 


474  REFORM    PERIOD. 

§  II.  Collection  of  Clinical  Observations. 

We  have  seen  that  the  physicians  of  the  Erudite  Period,  having 
observed  and  described  diseases  with  more  care  than  physicians  of  the 
middle  ages,  discovered  a  great  number  of  morbid  species,  which  had 
escaped  their  predecessors,  such  as  syphilis,  scurvy,  raphania,  etc. 
During  the  Keformative  Period,  the  number  of  medical  observers 
still  increased,  but  they  devoted  themselves  less  to  attempts  to  discover 
new  species,  than  to  determine  well  the  characters  of  those  which  already 
existed,  to  the  formation  of  more  exact  and  methodic  descriptions  and 
classifications,  as  before  remarked,  in  the  section  on  nosology.  Studies 
were  especially  directed  during  this  period,  to  the  influence  of  climates, 
seasons,  regimen,  and  epidemic  constitutions.  On  these  subjects  obser- 
vations had  long  been  neglected,  and  they  promised  an  ample  harvest  of 
discoveries,  for  the  progress  of  physics  and  chemistry  offered  to  men 
of  Art  the  means  of  establishing,  with  a  precision  unknown  to  the 
ancients,  the  variations  in  temperature,  the  qualities  of  the  air,  of  food 
and  drinks,  in  a  word,  the  influence  of  all  hygienic  agents.  It  is  then 
principally  under  this  aspect,  that  we  proceed  to  consider  the  results  of 
clinical  observations  collected  during  the  last  two  centuries. 

Hippocrates  had  left  to  his  successors  a  brilliant  outline  of  medical 
topography,  in  his  treatise  on  Airs,  Waters  and  Places.  So,  also,  he 
left  them,  in  his  first  and  third  book  on  Epidemics,  some  tableaux  of 
epidemic  constitutions,  worthy  of  serving  as  models  in  the  epoch  when 
they  were  traced.  But  the  physicians  of  succeeding  ages  occupied 
themselves  but  little  with  these  objects,  notwithstanding  their  recog- 
nized utility,  because  they  required  continued  observations  during  a  long 
coui"se  of  years,  and  a  patience,  abnegation  and  stability,  which  became 
more  and  more  rare  among  physicians  after  the  decadence  of  the  Ascle- 
pidean  schools. 


§  III.     Epikemic   Constitutions. 

It  was  only  at  the  end  of  the  sixteenth  century,  when  the  Hippocratic 
method  began  to  obtain  a  preference  over  Galenism,  that  men  devoted 
themselves  to  the  study  of  the  influence  of  the  air,  regimen,  and  epi- 
demic constitutions.  William  Baillou  was  the  first  among  moderns, 
who  was  distinguished  for  his  researches  on  this  subject.  By  his  educa- 
tion, writings,  and  genius,  as  well  as  by  the  times  in  which  he  lived, 
this  physician  forms  the  transition  from  the  Erudite  to  the  Eeform 
Period,  and  presents  the  insensible  passage  from  the  Galenism  of  J. 
Fernel,  to  the  Hippocratism  of  Sydenham  and  Stoll.     Profoundly  versed 


CLINICS.  475 

in  the  Greek  and  Latin  classics,  prompt  at  repartee,  subtile  and  eloquent 

[ .    in  ai'gument,  he  was  surnamed,  iu  his  youth,  the  Plague  of  the  Bachelors. 

i     By  these  qualities,  he  belongs   to  the  class  of  philosophic,  or  erudite 

r    physicians,  who  followed  in  the  tracks  of  Galen  ;  but  what  is  extraor- 

'    dinary,  he  joined  to  this  accuteness  and  vivacity  of  spirit,  a  gentleness 

and  modesty  of  character  which  excited  the  love  of  his  colleagues  as 

much  as  his  talents  excited  their  respect.    They  gave  him  an  irrefutable 

proof  of  esteem  and  affection,  by  conferring  on  him  twice,  unanimously, 

the    title    of  Dean.      A    lover   of    independence,    but    much    more   of 

humanity,  while  he  refused  positions  at  court,  the  poor  always  found 

him  ready  to  give  them,  prodigally,  his  time,  his  attention,  and  succor  of 

every  kind.     At  the  expiration  of  his  deanship,  Baillou  devoted  himself 

entirely  to  the  practice  of  his  profession,  in  which  he  displayed  a  talent 

for  observation,  and  a  sincerity  and  exactness  in  his  epidemic  tableaux,. 

of  which  there  had  been  no  example  since    Hippocrates.     It  was  as  a 

practitioner  that  he  acquired  his  finest  titles   to   glory,  and  became 

worthy  to  be  placed  at  the  head  of  modern  Hippocratists.- 

Baillou  observed  and  described  the  epidemic  constitutions  that  reigned, 
in  Paris  from  the  year  1570  to  1580.  The  following  is  the  tableau  he 
traced,  of  one  of  these  constitutions:  "The  year  of  Grace  1573,  the 
weather  was  extremely  variable  during  the  whole  course  of  the  year, 
during  which  a  great  many  abnormal  diseases  were  seen — particularly 
quartan  fevers ;  and  what  was  more  astonishing  is,  that  these  fevers 
assumed  this  type  from  the  very  first.  The  old  physicians  stated  that 
twenty  years  before  thei-e  had  existed  a  similar  temperature,  and  that  a 
considerable  number  of  persons  had  died  of  quartan  fevers.  After  death, 
the  spleen  was  found  soft  and  shrunken,  the  bile  evaporated,  and  con- 
creted in  the  gall  bladder.  Those  who  were  attacked  with  double 
quartans,  or  complicated  fevers,  or  who  attempted  to  cure  themselves 
with  remedies,  nearly  all  succumbed.  In  the  beginning  of  January,  the 
fever  changed  in  character,  and  became,  in  some  cases  a  double  tertian, 
and  in  others  a  benign,  continued  fever.  Afterward,  an  infinite  num- 
ber of  persons  were  tormented  with  itching,  inflamed  pustules,  redness, 
and  articular  pains — chiefly  those  whom  the  fever  had  wasted  and  dried 
up.  Did  the  perspiration  which  was  observed  in  these  sufferers  from 
fever,  proceed  from  the  dryness  of  the  liver,  or  the  general  condition  of 
the  body?" 

He  joined  to  the  general  sketch  of  each  epidemic,  the  particular  history 

'^  He  was  born  in  Paris  in  1538,  and  died  in  IGIG,  aged  78  years.  The  best 
edition  of  his  works  has  been  published  under  the  title  of  OjKra  Mediea 
Omnia.    Geneva,  1762. 


476  REFORM    PERIOD. 

of  some  diseases,  and  commentaries,  whicli  develop,  confirm,  and  explain, 
the  principal  traits  of  the  general  description.  The  following  is  one  of 
these  histories,  which  I  have  purposely  chosen  among  the  briefest :  The 
spouse  of  the  Consul  Lysseus  was  taken,  in  the  seventh  month  of  preg- 
nancy, with  a  flux  like  a  dysentery,  accompanied  with  tenesmus.  Very 
soon  a  continued  fever  lighted  up.  She  went  to  stool  thirty  times, 
during  the  night,  and  only  made  ineffectual  efforts.  An  abortion  was 
feared.  The  disease  was  sustained  especially  by  an  abundance  of 
humors,  which  seemed  to  proceed  from  the  region  of  the  liver.  Ehubarb 
and  cassia  were  administered  successively,  as  well  as  clysters  variously 
composed.  A  vein  was  opened  twice.  Injections  into  rectum  were 
administered,  and  anodynes  were  given  in  every  form,  a  day  and  a 
night,  to  prevent  abortion.  The  patient  was  re-established."  This 
clinical  observation,  like  the  one  which  precedes  it,  is  conspicuous,  as 
is  seen,  by  the  clearness  and  conciseness  which  distinguish  the  legitimate 
writings  of  Hippocrates.  Possibly,  we  have  a  right  to  reproach  Baillou, 
as  well  as  his  model,  for  the  absence  of  sufficient  details,  but  it  is 
necessary  to  recall  that  the  French  Hij^pocrates  was  accustomed  to  add 
to  his  particular  histories  an  explanatory  commentary. 

A  curious  remark  to  make,  in  the  course  of  this  historic  period,  is, 
*that  in  proportion  as  the  authority  of  Hippocrates  increased,  that  of 
Galen  declined  ;  nevertheless,  until  the  end  of  the  sixteenth  century, 
these  two  princes  in  medicine  were  confounded  in  a  common  worship, 
and  Baillou  himself  quotes  both  indifferently,  in  his  commentaries. 
But,  after  him,  the  reaction  against  G-alenism  became  general ;  very 
soon  no  one  dared  invoke  the  authority  of  the  Pergamian,  while,  until 
the  latest  times,  men  of  the  highest  reputation — the  Baglivi,  the 
Sydenhams,  the  Stahls,  and  the  Pinels — boasted  for  themselves  the  title 
•of  Hippocratists.  What,  then,  is  the  difference  between  the  Galenism, 
or  the  Dogmatism  of  Galen,  Oribasis,  Avicenna,  and  J.  Fernel,  and  modern 
Hippocratism  ?  No  writer  has  taken  the  trouble  to  show  us  ;  no  one, 
perhaps,  has  stated  it  in  a  well-defined  manner.  We  will  undertake  to 
supply  their  silence,  and  trace  the  line  of  demarkation  which  separates 
these  two  doctrines. 

Por  this  purpose  we  recall  here  what  as  said  in  the  Anatomical 
Period  on  the  subject  of  the  ancient  Dogmatism  :  that  it  is  composed 
of  two  distinct  theories,  namely,  the  theory  of  coction  and  crisis,  and 
the  theory  of  four  elements,  or  four  primordial  humors.  Galen  and 
his  successors  embraced  this  doctrine  in  its  totality ;  they  enlarged, 
commented  upon,  and  endeavored  to  explain  by  it,  all  the  }ihenomeua  of 
animated  nature.  But  the  progress  of  physics  and  chemistry,  in  the 
.-sixteenth  century  having  demonstrated  the  errors  of  the  theory  of  four 


CLINICS.  477 

elements,  it  was  irresistably  necessary  to  renounce  that  part  of  the 
ancient  Dogmatism,  and  cling  only  to  the  first.  It  was  then  that  the 
sect  of  modern  Hippocratists  was  formed,  which  preserved  of  the  doctrine 
of  Hippocrates  only  the  dogma  of  coction  and  crisis,  founded  on  the 
existence  of  a  principle,  or  intrinsic  force,  inherent  in  every  living 
being,  and  presiding  over,  or  at  least  co-operating  in,  all  the  phenomena, 
whether  physiological  or  pathological,  that  are  developed  in  it.  The 
consequence  of  this  theory  is,  to  consider  every  derangement  of  the 
health  as  an  effort  of  nature,  or  the  vital  principle,  tending  to  remove 
the  obstacles  which  oppose  themselves  to  the  free  exercise  of  its  func- 
tions :  hence  the  aphorism,  that  the  physician  is  the  minister  of  nature — 
that  he  must  study  its  tendencies,  and  respect  them,  insomuch  as  they 
are  not  evidently  bad,  and,  in  short,  to  interfere  with  remedies  only 
when  the  vital  forces  appear  iuefl&cient,  or  sur-excited,  or  deviated.  One 
is  a  Hippoeratist,  in  the  modern  sense,  from  the  moment  he  admits  the 
autocratism  of  nature,  or  the  vital  forces,  no  matter  otherwise  how  much 
he  tend,  with  Sydenham,  toward  humoralism,  with  Stahl,  to  animism, 
or  with  Pinel,  to  solidism,  etc.  There  is,  as  is  seen  in  our  days,  great 
latitude  in  the  qualification  of  Hippocratists,  and  many  physicians  to 
whom  it  is  applied,  and  who  themselves  profess  it,  have  advocated 
doctrines  extremely  diverse. 

However  this  may  be,  we  have  not  to  examine  here  the  value  of  the 
fundamental  axiom  of  modern  Hippocratism.  That  examination  will 
be  more  appropriate  in  the  chapter  on  theories  and  systems.  It  has 
sufiiced  for  the  moment  to  show  in  what  modern  Hippocratism  differs 
from  the  ancient  Dogmatism — that  is,  from  Galenism. 

Thomas  Sydenham,  who  flourished  during  the  second  half  of  the 
seventeenth  century,  merits  the  surname  of  the  English  Hippocrates,  as 
much  on  account  of  his  medical  doctrine,  as  of  the  profound  study  he 
made  on  the  influence  of  epidemic  constitutions.  Partisan  of  the  phi- 
losophy of  Locke,  of  whom  he  was  the  cotemporary  and  friend,  he  was 
one  of  the  first  who  strove  to  bring  physicians  back  to  the  observation 
of  pure  and  simple  pathological  phenomena,  of  which  Hippocrates  had 
given  the  example  in  some  of  his  writings. 

We  give  here  some  maxims  extracted  from  the  works  of  Sydenham, 
which  seem  to  us  to  comprise  the  medical  philosophy  of  that  author : 
"In  the  first  place,"  he  says,  "it  is  necessary  to  reduce  all  diseases  to 
precise  and  determined  species,  with  the  same  care  and  the  same  exact- 
ness that  the  botanists  have  displayed  in  their  treatises  on  plants.  In 
the  second  place,  whoever  desires  to  give  a  history  of  a  disease,  should 
renounce  every  philosophic  system  and  hypothesis,  and  mark  exactly 
the  smallest  morbid  phenomena  which  are  clear  and  natural ;  imitating 


478  REFORM  PERIOD. 

thus,  the  painter?,  who,  in  their  portraits,  have  great  care  to  express 
even  the  slightest  marks  of  the  persons  whom  they  desire  to  represent. 
In  the  third  phxce,  it  is  necessary,  in  the  description  of  a  disease,  to 
expose  separately  the  proper  or  essential,  and  the  accidental  and  foreign 
symptoms.  In  fine,  the  seasons  that  favor  most  each  order  of  symp- 
toms must  be  carefully  marked.  These  are  not  the  only  things  neces- 
sary to  observe  in  writing  the  history  of  diseases,  but  they  are  the 
principal.""  Such  are,  in  regard  to  pathology,  the  general  principles  of 
Sydenham. 

In  regard  to  therapeutics,  he  expresses  himself  in  these  terms:  "  The 
great  Hippocrates,  after  having  established  as  a  solid  basis  of  his  Art, 
this  incontestible  axiom,  namely :  nature  cures  diseases ;  has  exposed, 
clearly,  the  symptoms  of  each  of  them,  without  having  recourse  to  any 
hypothesis  or  system,  as  may  be  seen  in  his  works.  He  has,  also,  given 
rules  for  treatment,  founded  on  the  course  which  nature  takes  in  the  pro- 
duction and  cure  of  diseases.  This  is  very  nearly  in  what  consists  the 
theory  of  the  father  of  Medicine,  and  all  he  demands  of  a  physician  is, 
to  succor  nature  when  she  is  overcome,  to  correct  her  when  she  errs,  and 
to  bring  herback  into  the  circle  which  she  has  just  abandoned.  It  is 
absolutely  impossible  for  a  physician  to  know  the  morbific  causes  which 
have  no  relation  to  the  senses;  neither  is  it  necessary."! 

It  is  easy  to  recognize  in  this  expose  of  principles,  the  doctrine  of  a 
modern  Hippocratist.  but  we  find  there,  also,  some  maxims  borrowed 
from  the  ancient  Empirics ;  such  as  the  following:  "It  is  necessary  to 
describe  the  pathological  symptoms  as  they  manifest  themselves,  with- 
out the  aid  of  any  hypothesis,  and  to  reduce  diseases  to  precise  and 
determined  species,  like  the  vegetable  species  formed  by  the  botanist. 
It  is  absolutely  impossible  for  a  physician  to  know  the  morbific  causes 
which  are  not  all  appreciable  to  the  senses."  The  first  of  these  projio- 
sitions  recalls,  evidently,  the  symptomatic  groups,  or  the  theorems  of 
the  ancient  Empirics;  the  second  excludes  the  research  of  the  so-called 
occult  or  essential  causes  against  which  those  philosophic  physicians 
constantly  protested.  It  it  on  this  account  doubtless,  that  some  writers, 
among  others,  Kurt,  Sprcngel,  have  ranked  Sydenham  among  the  secta- 
tors  of  Empiricism.  But  he  is  distinct  from  them  in  several  respects, 
principally  in  that  he  does  not  conform  to  his  own  sage  maxims  which 
we  have  just  (juoted,  but,  on  the  contrary,  he  transgresses  and  contra- 
dicts them  at  every  step.  I  might  quote  a  crowd  of  these  contradic- 
tions, but  shall  content  myself  with  the  two  following :  "  Every  specific 

'  (Euvres  tie  Medicine  Pratique,  preface,  sec.  7  to  12.     Translation  of  Janet. 
t  Ibid.,  10  to  15. 


CLINICS.  479 

disease,"  he  says,  "is  an  affection  which  proceeds  from  an  exaltation  or 
specific  alteration  of  some  of  the  humors  of  the  body.""'  Again,  wish- 
ing to  explain  the  generation  of  spring-fevers,  he  reasons  as  follows : 
'•  In  winter,  the  spirits  being  concentrated  by  the  cold,  become  strong  j 
afterward,  the  hea:  of  the  spring  puts  them  in  motion,  and  as  they  find 
themselves  mixed  among  the  viscous  humors  which  nature,  during  the 
winter,  has  accum  ilated  in  the  mass  of  the  blaod,  (though  these  humors 
may  be  still  less  tenacious  than  those  which,  dried  by  the  heat  of  sum- 
mer, cause  autumnal  fevers,)  the  spirits,  I  say,  finding  themselves 
embarrassed  and  overwhelmed  by  these  viscous  humors,  make  an  effort 
to  disencumber  themselves,  and  by  this  effort  produce  the  ebulition 
which  occurs  in  spring  fevers.  In  like  manner,  if  bottles  full  of  beer, 
which  have  been  long  kept  in  a  cool  cellar,  be  brought  close  to  a  fire, 
the  liquor  soon  bubbles  and  seeks  to  escape."!  I  have  no  need  to 
remark,  I  think,  how  far  the  pathogenetic  explication  which  we  have 
quoted,  passes  the  limits  of  sensible  phenomena  to  enter  into  the  laby- 
rinth of  hypotheses — how  much  they  are  opposed  to  the  sage  maxims 
proclaimed  above,  which  the  author  has  borrowed,  possibly  without  sus- 
pecting it,  from  the  Empirical  doctrines. 

Sydenham,  after  having  studied  with  admirable  patience  for  fifteen 
consecutive  years,  the  influence  of  epidemic  constitutions,  thought  he 
could  emit,  on  that  subject,  the  following  theory:  "There  are  various 
constitutions  of  the  year,  which  come  neither  from  heat,  cold,  drouth 
nor  humidity,  but  rather  from  a  concealed  and  inexplicable  alteration, 
which  occurs  in  the  bowels  of  the  earth.  Then  the  air  is  found  affected 
with  pernicious  exhalations,  which  cause  special  diseases,  as  long 
as  the  same  constitution  is  predominant.  In  fine,  at  the  end  of  a  few 
years  this  constitution  ceases,  and  gives  place  to  another.  Each  general 
constitution  produces  a  fever  which  is  proper  to  it,  and  which,  outside  of 
that,  never  appears.  For  this  reason,  I  call  these  sorts  of  fevers  stationary, 
or  fixed."  | 

"What  appears  to  me  especially  difficult,"  he  says,  further  on,  "is  to 
know,  in  the  commencement  of  a  constitution,  the  species  of  fever  which 
is  going  to  prevail,  since,  until  then,  no  specimen  of  it  has  been  seen. 
o  o  o  g^t  though  it  may  be  difficult  to  foresee,  certainly,  the  new 
species  of  fever  which  is  about  to  commence — and  when  even  that  must 
be  supposed  entirely  impossible,  we  have,  at  least,  always  the  resource 
of  directing  the  treatment  upon  general  principles.     By  this  means  we 

''  Preface  to  (Euvres  de  Medicine  Pratique.     Translation  of  Janet. 
f  History  and  Curation  of  Acute  Diseases.     Sec.  i,  chap.  5. 
jlbid. 


480  REFORM  PERIOD. 

are  enabled  to  place  our  patient  out  of  danger,  provided  we  proceed  cau- 
tiously, without  too  much  haste — for  there  is  nothing,  according  to  my 
view,  more  pernicious  than  precipitation,  nor  anything  which  causes  the 
death  of  more  persons  who  are  attacked  with  fevers."'-' 

There  is  no  question  but  that  we  see  epidemics  frequently  developed, 
the  production  of  which,  possibly,  can  be  attributed  neither  to  variations 
in  the  atmosphere,  nor  to  the  qualities  of  the  regimen,  nor  to  any  other 
known  cause.  It  is  equally  evident  from  common  experience,  that 
when  an  epidemic  reigns  with  a  high  degree  of  intensity,  it  impresses  on 
all  intercurrent  diseases  a  particular  character,  which  requires  a  modi- 
fication of  th€  treatment,  according  to  the  nature  of  the  epidemic.  This 
is  what  all  attentive  practitioners  have  observed,  and  which  did  not 
escape  the  notice  of  any  physician  in  Paris  during  the  cholera  epidemic 
in  1832.  But  to  pretend  that  there  exists  all  the  time,  an  epidemic 
constitution,  or  stationary  fever,  independent  of  the  influence  of  the 
regimen  and  atmospheric  vicissitudes,  a  constitution  that  would  change 
the  natural  character  of  diseases  and  necessitate  grave  modifications  in 
their  treatment,  is  to  generalise  a  particular  observation — is  to  erect  an 
exceptional  fact  into  a  rule.  A  similar  theory,  if  it  could  be  admitted, 
would  take  from  therapeutical  precepts  all  stability,  and  would  trans- 
form medical  practice  into  a  continual  groping — a  consequence  that 
Sydenham  himself  did  not  disown  in  the  last  quotation,  and  which  is 
in  itself  sufficient  to  cause  the  rejection  of  his  doctrine. 

This  doctrine  has,  however,  a  great  number  of  sectators  of  the  highest 
merit,  among  whom  we  must  place  in  the  first  rank,  Maximillian  Stoll 
and  Philip  Pinel.  The  celebrated  professor  of  Vienna,  whose  talents 
for  observation  cannot  be  questioned,  strives,  with  a  zeal  more  merito- 
rious than  fortunate,  to  unravel  the  theory  of  epidemic  constitutions ; 
but  though  he  expresses  himself,  on  this  subject,  with  more  precision 
than  any  other,  he  has  not  been  able  to  dispel  the  obscurity  that  rests 
upon  it ;  because  he  has  himself  extended  beyond  measure,  the  idea  of 
stationary  fevers,  as  is  easy  to  be  seen  by  the  following  passage : 

"  The  stationary,"  he  says,  "  is  embraced  in  a  certain  number  of 
years  ;  it  gradually  increases  till  it  attains  its  hight,  then  declines, 
giving  place  to  another  stationary,  which  succeeds  it.  Do  these  same 
stationaries  return  in  a  fixed  and  certain  order,  after  a  certain  number 
of  years  ?  Are  they  limited  in  number?  Or  do  they  produce,  sometimes, 
new  ones?  These  questions  cannot  be  determined,  on  account  of  the 
absence  of  observations  made  during  a  long  course  of  years  by  skillful 
physicians  in  one  locality,  and  compared  with  similar  observations  made 


Hist,  et  Cur.  Maladis  Aiguiis,  sec.  iv.,  chap.  vi. 


CLINICS.  481 

by  others.  Thus  we  arc  ignorant,  up  to  this  time,  of  the  nature,  num- 
ber, extent,  and  period  of  stationary  fevers :  Solely  it  is  established 
after  the  observations  of  Sydenham  and  my  own,  that  a  stationary  fever 
extends  its  influence  on  all  absolutely  febrile  diseases,  and  that  it  con- 
trolls  them,  whether  they  are  independent  of  the  changes  of  the  season, 
or  proceed  from  any  isolated  cause.  It  is  no  less  certain  that  the 
stationary  fever  exercises  a  great  influence  on  chronic  diseases,  whether 
febrile  or  not."  " 

Independently  of  the  stationary  fever,  a  species  of  protean,  present  in 
all  places,  in  all  time,  associated  with  all  diseases,  clothed  in  all  forms, 
without  having  any  of  its  own,  the  same  authors  admit  other  fevers, 
which  they  name,  sometimes  sporadic,  or  intercurrent,  and  again, 
annual,  or  cardinal.!  There  are,  according  to  Stoll,  four  sorts  of  annual 
fevers,  namely :  the  injiammatory,  which  prevails  most  in  the  winter, 
and  at  the  commencement  of  spring ;  the  bilious,  which  predominates  in 
the  heat  of  summer,  and  at  the  beginning  of  autumn ;  the  pituitous, 
which  shows  itself  in  the  passage  of  autumn  into  winter,  and  of  winter 
into  spring ;  finally,  the  intermittent,  which  appears  in  the  spring  and 
autumn.  Annual  fevers  take,  often,  their  vulgar  name  from  some 
dominant  symptom ;  thus  they  are  called  pleuritic,  miliare,  petechial, 
rheumatic,  morbilous,  variolic,  etc.,  when  they  are  accompanied  with 
pleurisy,  miliary,  or  petechial  eruptions,  rheumatism,  etc.  \ 

Xotwithstanding  my  respect  for  such  observers  as  Sydenham,  Stoll, 
and  Pinel,  I  can  regard  their  stationary  fevers  only  as  an  allusion,  a 
Utopia,  which  resembles  the  quid  divinum,  zc  Osiov,  of  the  ancients, 
an  expression  by  which  they  were  accustomed  to  designate  the  unknown 
cause  of  all  strange  and  inexplicable  phenomena.  In  regard  to  annual 
or  sporadic  fevers,  no  one  doubts  their  reality,  for  each  of  them 
manifests  itself  by  evident  and  palpable  signs  that  are  appropriate 
to  it.  Thus  the  pathological  state  which  is  designated  under  the  name 
of  inflammatory  fever,  is  very  distinct  from  that  which  is  named  bilious 
fever,  whatever  opinion,  otherwise,  one  may  have  on  the  origin  and 
reciprocal  relations  of  the  two  states  ;  so,  pleuritic  fever,  or  pleurisy,  is 
perfectly  distinct  from  miliary  eruption,  rheumatism,  variola,  etc.,  when 
however  these  divers  affections  do  not  co-exist,  nor  are  complicated  in 
the  same  subject. 

"  Aphiorisms  on  the  Knowledge  and  Cure  of  diseases.   Translated  by  Corvisart. 

t  "  The  stationary  fever,"  says  Stoll,  "is  disguised  frequently,  and  in  various 
•ways.  It  imitates  different  diseases,  though  at  bottom,  its  character  may  be 
everywhere  the  same,  and  the  method  of  treatment  the  same  in  every  case." 
(Apho.  .391.)  t  Aphor.  39,  41. 


482  REFORM    PERIOD. 

§  IV.  Medicvl  TorOGEATHY. 

The  study  of  ]\redical  Topography  is  intimately  united  with  that  of 
epidemic  constitutions;  these  two  branches  of  science  should  go  together; 
they  mutually  enlighten  and  complement  each  other.  The  cultiva- 
tion of  both  commenced  about  the  same  epoch,  namely,  during  the 
second  half  of  the  sixteenth  century.  Prosper  Alpin  was  one  of  the 
first  to  occupy  himself  with  topography,  in  a  medical  point  of  view. 
He  wrote  a  book  on  the  natural  history  of  Egypt,  the  diseases  of  its 
inhabitants,  the  ancient  and  modern  medicine  of  the  country — full  of 
judicious  and  erudite  reflections,  in  which  the  good  taste  of  the  author 
is  prominent.  James  Bontius  collected  interesting  observations  on 
the  natural  productions  of  the  West  Indies,  and  on  the  diseases  which 
habitually  prevail  there.  William  Pison  wrote  a  similar  work  on 
Brazil,  and  united  afterwards,  in  the  same  edition,  his  work  with  that 
of  Bontius,  under  the  title  of  Historia  Naturalis  et  Medica  Indies 
Orientalis.  The  celebrated  traveler  Koempfer,  collected  a  mass  of 
excellent  observations  on  medicine  and  botany,  during  the  ten  years  he 
employed  in  travels  in  Persia.  Armenia,  Japan,  the  Kingdom  of  Siam, 
and  other  parts  of  Eastern  Asia. 

In  his  history  of  the  diseases  of  St.  Domingo,  J.  B.  Poupe  Desportes, 
arranged  the  medical  topography  of  the  island,  and  described  the 
epidemic  constitutions  which  he  had  observed  there,  from  1732  to 
1747.  George  Cleghorn  studied,  with  much  care  and  sagacity,  for 
thirteen  years,  the  endemic  and  epidemic  aifections  of  the  island  of 
Minorca,  the  manners  of  the  people,  the  qualities  of  its  atmosphere,  and 
the  nature  of  the  soil  and  its  productions.  He  remarked  a  great 
analogy  between  the  diseases  of  that  country,  and  those  described  by 
the  ancients,  Avhich  he  attributed  to  the  conformity  of  the  climate  of 
Greece,  with  that  of  the  above  mentioned  islands.'-'  J.  Lind  wrote  an 
excellent  treatise  on  the  Diseases  of  Europeans  in  hot  climates,  and  on 
the  means  of  preserving  the  health  of  sea-faring  men  during  long 
voyages.  William  Hillary,  made  meteorological  and  medical  observa- 
tions in   the  island  of  Barbadoes.f     Lionel   Chalmers,    wrote   on   the 

''■  Observations  on  the  Epidemical  Diseases  in  Minorca,  from  1741 — 1749.  Lon- 
don. 1779,  in-8. 

•f  Observations  on  the  change  of  the  air,  and  the  concomitant  epidemical 
diseases,  in  the  Island  of  Barbadoes.  London,  1759,  in-8. — Comparez  J.  Hendy. 
Memoire  sur  la  maladie  glandulaire  de  Barbade  (  Memoires  de  la  Societe  Me'di- 
cale  d'e'mulation,  Paris,  an  ix,  T.  IV,  p.  44,1  et  Alard.  De  I'inflammation  des 
Vaisseaux  absorbants,  lymphatiques,  dermoides  et  sous-cutanes,  etc.  Paris, 
1824,  in-8,  fig. 


CLINICS.  483- 

climate  and  diseases  of  South  Carolina.  Bajon,  addressed  to  the 
Academy  of  Xatural  Sciences  of  Paris,  several  memoirs,-'  which 
obtained  the  approbation  of  that  learned  association,  concerning  the 
medical  topography  of  Cayenne,  and  of  French  Guiana,  the  mal  rouge 
of  Cayenne,  and  the  effects  of  the  climate  on  newly  arrived  Euro- 
peans, etc. 

In  Europe  a  strong  impulse  was  given  to  the  study  of  topography : 
a  multitude  of  researches  were  undertaken  with  this  object.  Learned 
societies  often  put,  in  conconrs,  questions  relative  to  the  medical 
topography  of  the  places  in  which  they  were  held  ;  many  physicians 
published  spontaneously  the  result  of  their  observations  in  the  countries 
where  they  practised;  asjnrants  to  the  doctorate  often  took  as  a  subject 
for  their  theses,  the  description  of  localities  where  they  designed  to 
locate  for  the  practice  of  their  profession.  There  was  not  a  province 
or  a  city  of  considerable  size,  which  did  not  become  the  subject  of  one 
or  several  topographical  monographs. f 

Finally,  an  effort  was  made  to  collect  all  the  observations  that  had 
been  published  on  this  subject,  in  every  part  of  the  world,  and  to 
compose  from  them  a  general  geography  for  the  use  of  physicians,  in 
which  all  the  diseases  proper  to  each  climate,  and  each  country,  should 
be  clearly  defined,  with  the  probable  causes  of  their  development  and 
the  method  of  treating  them.  William  Falconer  was  the  first  who 
published  a  work  of  this  character,  entitled,  Eemarks  on  the  Influence 
of  Climate,  Geographical  Situation,  Xature  of  the  Soil,  Inhabitants, 
Quality  of  Food,  and  Mode  of  Living ;  Dispositions,  Temperaments, 
Manners  of  the  People,  Intelligence,  Laws  and  Customs,  Forms  of 
Government,  and  Picligion  of  the  Human  Pace.  But  the  execution  of 
the  work  so  pompously  announced,  was  far  from  responding  to  the 
promises  of  the  title.  Some  years  after,  Leonard  Louis  Finke  published 
a  general  geography  of  practical  medicine — an  incomplete  and  undigested 
compilation,  but  richer  in  facts,  and  exact  observations,  than  the 
preceding. 

To  give  an  idea  of  the  multitude  of  objects  included  in  the  medical 
topography  of  a  country,  I  will  here  transcribe  the  programme  which 
was  summed  up  by  the  Eoyal  Society  of  Medicine,  of  Paris,  in  proposing 
for  a  prize  essay,  the  examination  of  the  geographical  situation  of  that 
capital,  and  its  environs  : 

^  Memoires  pour  servir  a  1'  Histoire  Naturelle  de  Cayenne  et  de  la  Guiane 
Francaise.     Paris,  1777,  2  vol.  in-S. 

t  Several  Medical  Topographe's  worthy  to  be  consulted,  are  published  in  the 
Memoires  de'  la  Societe'  Royal  de  Med.  Paris,  1776-1790,  10  vol.  4vo,  See  also 
Recueil  d'Observations  de  Medicine  des  Hospitaux  Militaire,  etc. 


484  REFORM   PERIOD. 

''  Determine  what  are  the  mountains  or  hills  that  concur  in  the 
formation  of  the  Paris  basin,  and  that  are  found  in  its  environs.  "What 
is  their  extent,  their  form,  and  their  elevation  above  the  ordinary  level 
of  the  Seine  ?  What  is  their  position  relative  to  the  four  cardinal 
points  of  the  horizon,  their  respective  distance,  their  connections  among 
themselves,  by  their  projecting  and  receding  angles,  their  situation  and 
direction  in  relation  to  the  city  ?  What  is  their  internal  composition, 
the  nature  of  their  soil,  and  of  that  of  the  valleys  formed  by  them, 
and  lastly,  what  is  the  extent  and  direction  of  these  valleys  ?  What 
arc  the  position  and  extent  of  the  forests  planted  in  the  environs,  their 
distance  from  the  city,  the  quality  of  their  soil,  the  species  and  average 
hight  of  their  trees  ? 

"  What  are  the  running  or  stagnant  waters  that  are  found  in  the 
neighborhood,  either  constantly  or  only  at  certain  times  of  the  year  ? 
What  is,  independently  of  the  river  water,  the  quality  of  drinking 
water,  and  the  changes  it  undergoes  at  different  seasons  ?  What  are 
the  courses  of  the  usual  winds,  and  what  obstacles,  what  deviations  and 
modifications,  do  they  undergo  from  the  forests,  the  mountains,  and 
valleys  ?  Lastly,  what  are  the  different  productions  for  the  use  of  men 
and  animals,  furnished  by  the  surrounding  country." 

This  programme,  as  is  seen,  includes  only  a  part  of  the  documents 
which  compose  medical  topography  ;  to  complete  itj  it  would  be  neces- 
sary to  add  a  general  view  of  the  city,  its  streets,  squares,  and  the 
public  and  private  edifices  of  the  population ;  to  describe  the  physical 
constitution  of  the  inhabitants,  their  tastes,  inclinations,  manners, 
nutrition,  clothing,  civil  and  political  state,  etc.  ;  lastly,  to  give  an 
account  of  their  endemic  and  epidemic  diseases. 

A  scheme  so  vast  is  not  easy  to  fill,  for  a  city  like  Paris,  and  much 
less  still  for  a  great  province  or  a  kingdom.  It  requires  extended  and 
varied  knowledge,  an  immense  number  of  positive  observations,  a  spirit 
of  analysis  to  decompose  the  facts,  and  to  ascertain  their  elements,  a 
synthetical  genius,  to  connect  them  according  to  their  analogies,  and 
deduce  from  them  general  consequences.  How  would  it  be  if  one 
wished,  in  work  of  this  kind,  to  comprehend  one  of  the  four  great 
divisions  of  the  terrestrial  globe,  or  of  the  entire  globe  itself?  The 
life  of  a  man  would  not  be  sufficient  for  it,  whatever  might  be  his  capa- 
city, and  we  feel  that  an  enterprise  of  this  importance  can  not  be 
attempted  except  by  a  learned  society,  and  executed  in  the  period  of  a 
great  number  of  years,  with  the  concurrence  of  savans  and  physicians 
disseminated  over  all  parts  of  the  earth.'-' 

*■'  The  late  lamented  and  eminent  Prof.  Daniel  Drake,  M.  D.,  made  a  contribution 
to  Jledical  Science  on  this  subject,  that  has  no  parallel  in  medical  literature.     See 


THEORIES   AND   SYSTEMS.  485 

C  H  A  P  T  E  Pt     X  . 

THEORIES    AND    SYSTEMS. 

PRELIMINARY    REFLECTIONS. 

The  philosopliic  system  of  Aristotle,  and  the  medical  system  of  Galen, 
had  resisted  the  attacks,  more  violent  than  skillful,  of  the  innovators  of 
the  sixteenth  century.  By  the  help  of  some  modifications  in  details, 
these  systems  had  appeared  sufficient  to  the  majority  of  minds  to  explain 
the  rationale  of  observed  phenomena  in  the  mental,  moral,  and  physical 
world.  Those,  even,  vpho  found  them  insufficient  or  defective  in  some 
respects,  still  preferred  them  to  most  of  the  hypotheses,  more  brilliant 
than  solid,  of  the  modern  Platoneans,  and  to  the  crude  lucubrations  of 
the  propagators  of  the  Occult  Sciences.  Thus,  the  doctrines  of  the 
schools  sustained  themselves  less,  perhaps,  by  their  intrinsic  merits  than 
by  the  feebleness  of  their  adversaries,  because  these  had  up  to  that 
time  proposed  nothing  better,  or  that  was  even  comparable  to  them.  It 
may  be  said,  perhaps,  that  under  this  state  of  things  it  was  wiser  to 
rest  in  doubt  and  waiting,  without  pronouncing  in  favor  of  any  party. 
To  this  counsel  I  shall  offer  only  this  objection :  it  was  impracticable. 
Indeed,  of  speculative  truths  we  may  certainly  rest  in  doubt  and  wait- 
ing ;  thus,  we  may  doubt  all  our  lives  if  there  are  several  sorts  of  spirits 
in  the  animal  economy,  as  indicated  by  Galen,  or  if  there  is  only  one 
sort,  as  is  asserted  by  Laurent  Joubert ;  but  in  regard  to  practical 
truths,  doubt  and  waiting  are  impossible.  For  example,  let  a  physician 
be  called  to  a  patient :  he  must  necessarily  prescribe  something  or 
nothing.  Xow,  if  he  order  nothing,  he  takes  a  position,  just  as  much  as 
if  he  had  ordered  something.  "We  thus  see  that  the  practitioner  can 
not  remain  indifferent  in  regard  to  therapeutical  methods,  and  that, 
from  taste  or  compulsion,  with  or  without  conviction,  he  is  obliged, 
every  day  and  at  each  moment,  to  adopt  one  of  them.  It  is,  therefore, 
important  that  he  study  and  compare  them  well  beforehand,  in  order  to 
adopt  the  best,  or,  if  you  please,  the  least  defective — the  one  which  offers 
the  best  guarantee  of  success.  To  defer  this  examination,  to  take  no 
thought  in  each  circumstance,  except  from  the  inspiration  of  the 
moment,  is  to  exhibit  ourselves  unworthy  of  the  medical  priesthood — is 
to  play  odd  and  even  with  the  lives  of  our  fellows. 

his  Systematic  Treatise,  Historical,  Etiological,  and  Practical,  on  the  Principal 
Diseases  of  the  Interior  Vallej'  of  North  America,  as  they  appear  in  the  Caucas- 
ian, African,  Indian,  and  Esquimaux  varieties  of  its  population.  Vol.  I.  Cin- 
cinnati, 18-50.— Tr. 


486  REFORM   PERIOD. 

But  tlic  time  approached  when  men  more  powerful  in  genius  and  sci- 
ence, began  to  demolish  the  antique  edifice  of  human  knowledge,  in  order 
to  reconstruct  it  on  new  foundations.  Already  Martin  Luther,  the 
boldest  of  the  innovators  of  the  sixteenth  century,  having  proclaimed 
the  liberty  of  investigation  in  matters  of  religion,  drew  after  him  a 
notable  part  of  Europe.  Copernicus  and  Galileo  had  opened  the  route 
in  which  Newton  afterward  immortalized  himself  by  almost  fabulous 
conceptions.  Natural  history,  Physics,  Chemistry,  and  Medicine  were 
enriched,  every  day,  by  facts  that  were  in  manifest  contradiction  to 
received  theories.  The  necessity  of  a  general  recast  of  the  sciences 
was  more  and  more  felt;  the  ancient  philosophic  doctrine  could  not  sus- 
tain itself  in  the  midst  of  the  crumbling  ideas  which  had  served  to  build 
it  up. 

Thus  the  Reform  Period  witnessed  the  appearance  no  longer  of 
mere  simple  outlines,  such  as  we  have  signalized  in  the  preceding  period, 
but  complete  systems  of  philosophy,  wisely  elaborated  by  minds  of  the 
first  order :  systems  which  have  exercised  a  marked  influence  on  the 
march  of  the  human  mind,  and  on  that  of  Medicine  in  particular ;  sys- 
tems of  which  it  is  indispensable  to  have  a  summary  idea,  in  order  to 
comprehend  and  appreciate  modern  medical  theories. 


A.RT.   I.     HISTORIC     SKETCH    OF    PHILOSOPHY    DURINtI    THE    SEVENTEENTH   AND 
EIGHTEENTH    CENTURIES. 

§  I.    Retrospective  Constderatioxs. 

The  magi  of  the  East,  the  priests  of  Egypt,  and  the  most  ancient 
philosophers  of  Greece,  were  persuaded  that  to  make  a  grand  jirogress 
in  science,  as  well  as  in  wisdom,  there  were  no  better  means  than  to 
separate  from  the  crowd  and  the  noise  of  life,  become  isolated  from  all 
external  sensations,  and  meditate  deeply  on  the  great  truths  which 
constitute  real  knowledge  and  lead  to  true  happiness.  Such  was  the 
aim  of  the  institutions  which  Pythagoras  founded  in  Italy — imposing 
silence  on  his  disciples ;  and  such  was  the  advice  that  Plato,  heir  of 
the  doctrine  of  Socrates,  gave  to  his  scholars.  It  is  necessary,  he  says, 
in  order  to  arrive  at  a  knowledge  of  the  truth,  to  retire  within  one's 
self,  and  be  freed,  as  much  as  possible,  from  all  outward  impressions,  so 
that  the  soul,  disengaged  by  thought  from  the  bonds  of  the  body,  may  rise 
in  full  liberty,  toward  the  eternal  essence  whence  it  emanated  ;  for 
there  is  the  source  of  all  light ;  it  is  there  only  that  our  spirit  will 
find  science,  and  repose  in  recalling  its  celestial  origin. 


THEORIES   AND   SYSTEMS.  487 

This  mettod,  which  we  name  intuitive,  or  reflective,  led  the  earliest 
sages  to  the  discovery  of  the  moral  and  religious  truths  which  are  the 
base  of  the  social  order.  By  it,  they  elevated  themselves  to  the  idea  of 
one  God,  eternal  and  infinite — Sovereign  Arbiter  of  the  destinies  of 
the  world  ;  to  the  idea  of  the  immortality  and  spirituality  of  the  soul ; 
to  the  ideas  of  justice,  virtue,  future  rewards,  etc.  It  is  also  by  this 
intuitive  method  that  mathematical  axioms  are  discovered;  axioms 
which  charm  us  by  their  infallibility,  and  from  which  are  deduced,  by 
reasoning  from  irresistible  evidence,  an  infinity  of  theorems,  more  and 
more  admirable.  It  was  especially  this  infallibility  of  mathematical 
reasoning  that  led  the  philosophers  to  introduce  the  same  method  into 
all  the  sciences.  They  flattered  themselves  that  by  following  exactly 
the  same  course  for  every  class  of  ideas,  they  could  advance  with  the 
same  certainty.  Was  it  not  natural,  indeed,  to  desire  to  generalize  a 
mode  of  acquisition  which  had  produced  such  satisfactory  results  in  so 
many  respects ;  and  must  we  not  excuse  Plato  when  he  seeks  in  ideas, 
purely  abstract,  the  secret  of  the  creation  of  the  world,  and  the  explana- 
tion of  natural  phenomena ;  when  he  essays  to  establish  a  system  of 
cosmogony  on  geometric  abstractions,  by  supposing,  for  example,  the 
number  of  primitive  triangles  that  should  compose  each  of  the  material 
elements. 

Nevertheless,  the  men  who  made  a  particular  study  of  the  physical 
world,  such  as  Democritus,  Hippocrates,  and  Aristotle,  did  not  fail  to 
perceive  that,  in  order  to  arrive  at  a  knowledge  of  the  properties  of 
matter  in  general,  and  of  bodies  in  particular,  mental  reflection,  apart 
from  all  impressions  on  the  senses,  was  not  sufficient ;  but  that  we 
must,  on  the  contrary,  give  great  weight  to  these  impressions,  and  make 
them  the  basis  of  our  judgment  in  what  relates  to  the  order  of  sensible 
things.  Hippocrates  was  one  of  the  first  who  proclaimed  the  necessity 
of  observation  in  medicine,  and  the  impossibility  of  discovering  the 
causes  of  diseases,  their  nature,  their  course  and  their  efi"ects,  by  any 
other  plan.  Aristotle  generalised  to  excess,  perhaps,  the  thoughts  of 
Hippocrates,  when  he  affirmed  that  all  our  knowledge  is  derived  from 
sensation — ''Nihil  est  iji  intellectu  quod  non  prius  fuerit  in  sensu."  But 
he  did  not  mean  to  say  by  this  that  we  acquire  ideas  by  the  senses  only ; 
he  meant,  merely,  that  the  first  ideas  that  arise  within  us,  and  which  are 
the  foundation  of  all  the  rest,  are  derived  from  the  senses. 

Aristotle,  though  having  an  opinion  diametrically  opposite  to  that  of 
Plato,  on  the  origin  of  our  acquirements,  agreed  with  him  in  saying  that 
the  first  notions  that  are  formed  in  our  minds  are  very  general  ones — 
mother  ideas — principles.  Now,  as  we  have  demonstrated  in  a  former 
section,  this  is  a  very  grave  philosophic  heresy,  and  it  drew  these  two 


488  REFORM    PERIOD 

philosophers  and  tteir  successors  into  an  inextricable  labyrinth  of 
subtilties  and  contradictions.  For  more  than  two  thousand  years  it 
was  the  established  rule  to  place  at  the  head  of  all  treatises,  general 
axioms,  which  were  very  improperly  named  principles ;  and  efforts  were 
subseipently  made  to  deduce  from  these  principles  a  series  of  proposi- 
tions, more  or  less  logically  connected.  Observation,  when  one  deigned  to 
consult  it,  served  only  to  lay  the  first  foundation  of  the  scientific  edifice  ; 
reasoning  must  do  the  rest.  Such  was,  with  some  exceptions,  the  mode 
of  proceeding  of  all  the  authors  and  philosophers,  particularly  till 
toward  the  close  of  the  sixteenth  century  of  the  Christian  era. 

At  that  epoch  the  method  of  pure  observation  had  partially  pene- 
trated into  some  branches  of  human  knowledge,  such  as  physics, 
chemistry,  and  astronomy,  and  bad  produced  admirable  results,  which 
had  greatly  shaken  the  scholastic  philosophy.  It  now  needed  only  the 
the  advent  of  a  generalizing  and  profound  mind,  who  would  dare 
penetrate  to  the  base  of  our  ideas,  and  succeed  in  finding  a  form  of 
reasoning  less  defective  than  that  generally  adopted.  Now,  two  men 
of  a  character  and  genius  very  different,  appeared  nearly  at  the  same 
time,  both  attempting  this  great  enterprize.  The  first  was  Francis 
Bacon — the  second  Rene  Descartes. 


§  II.     Ox  Modern-  Sensualism  and  Reasoning  by  Induction. 

Bacon,  versed  early  in  the  management  of  men  and  affairs,  endowed 
with  a  fine  and  positive  mind ;  cultivating  by  predilection  the  natural 
sciences,  physios  and  chemistry,  was  one  of  the  first  to  feel  and  point 
out  clearly  the  defect  of  the  method  adopted  till  then,  of  placing  at  the 
foundation  of  the  sciences,  the  most  general  axioms.  '•  There  are  and 
can  exist  but  two  ways  of  investigating  and  discovering  truth.  The 
one  hurries  on  rapidly  from  the  senses  and  particulars,  to  the  most 
general  axioms,  and  from  them,  as  principles,  and  their  supposed  indis- 
putable truth,  derives  and  discovers  intermediate  axioms.  This  is  the 
way  now  in  use.  The  other  constructs  its  axioms  from  the  senses  and 
particulars,  by  ascending  continually  and  gradually,  till  it  finally 
arrives  at  the  most  general  axioms,  which  is  the  true  but  unattempted 
way."  * 

This  is  a  very  important  passage,  and  merits  to  fix  our  attention  ; 
for  it  lays  down  in  the  clearest  manner  the  difference  that  exists  between 
modern  sensualism  and  the  sensualism  of  Aristotle.      Let  us  recall, 

"  Novum  Organum,  Book  i.,  chap,  i.,  Aphorism  xix. 


THEORIES   AND   SYSTEMS.  489 

indeed,  the  extremely  subtile  sophisms  by  which  the  Macedonian  philo- 
sopher proved  that  the  first  ideas  which  are  formed  in  our  minds 
through  the  instrumentality  of  the  senses,  are  very  general  ideas ; 
whence  he  concludes,  that  in  all  sciences  we  should  commence  by  the 
most  universal  axioms/--'  Bacon,  without  seeking  to  unravel  the  knot 
of  this  sophism,  contents  himself  with  establishing  a  rule  entirely 
contrary,  which  consists  in  passing  from  sensations  to  particular  facts, 
then  from  these  to  more  extended  notions,  and  so  on,  rising  by  grada- 
tion from  individual  facts  to  notions  more  and  more  general,  up  to  the 
most  universal  axioms,  which  form  the  crown,  and  not  the  base,  of 
natural  sciences. 

It  has  been  customary  to  regard  Bacon  as  the  restorer  of  the  method 
of  observation,  and,  in  fact,  he  continually  asserts  it  in  his  works  ; 
but  many  others  before  him  have  proclaimed  it  with  no  less  persistence, 
and  have  consequently  been  able  to  avail  themselves  of  a  much  better 
method  to  reach  great  discoveries.  Whence,  then,  the  exclusive  honor 
attributed  to  him,  of  having  re-established  this  method  ?  Because  he 
gave  it  a  new  development,  and  was  the  first  to  teach  that  particular 
ideas  are  the  base  of  the  scientific  pyramid,  and  axioms  are  its  summit. 
This  was,  indeed,  a  radical  innovation,  full  of  the  future,  the  importance 
of  which  was  completely  realized  by  Bacon  ;  for  he  often  speaks  of  it 
with  enthusiasm,  and  praises  it  as  an  unparalelled  discovery.  "  No 
one  has  yet  been  found  possessed  of  sufficient  firmness  and  severity  to 
resolve  upon  and  undertake  the  task  of  entirely  abolishing  common 
theories  and  notions,  and  applying  the  mind  afresh,  when  thus  cleared 
and  elevated,  to  particular  researches ;  hence  our  human  understanding 
is  a  mere  farrago,  and  crude  mass,  made  up  of  a  great  deal  of  credulity, 
and  accident,  and  the  puerile  notions  it  originally  contracted.  But  if  a 
man  of  mature  age,  unprejudiced  senses,  and  clear  mind,  would  betake 
himself  anew  to  experience  and  particulars,  we  might  hope  much  more 
from  such  a  one  ;  in  which  respect  we  promise  ourselves  the  fortune  of 
Alexander  the  Great !  "  f 

In  another  work,  the  English  metaphysician,  desiring  to  signalize 
more  and  more  his  method,  and  its  difference  from  the  ancient  one. 
expresses  himself  in  these  terms :  "  The  end  of  our  new  logic  is  to  find, 
not  arguments,  but  arts  ;  not  what  agrees  with  principles,  but  principles 
themselves  ;  not  probable  reasons,  but  plans  and  designs  of  works — a 


"  See  his  philosophic  doctrine :  Phil.  Period.  In  this  sophism  Aristotle  con- 
founds, without  knowing  it,  general  ideas  with  confused  ideas,  which  are  very 
different.     Hence  his  errors,  and  those  of  the  writers  who  have  followed  him. 

t  Loo.  Cit.,  Aphorism  xcvii. 

31 


490  REFORM   PERIOD. 

different  intention,  producing  a  different  effect.  -■■'  =•■'  =■■'  The  nature 
and  order  of  the  demonstrations  agree  with  this  object.  For  in  common 
logic,  almost  our  whole  labor  is  spent  upon  the  syllogism.  Logicians, 
hitherto,  appear  scarcely  to  have  noticed  induction,  passing  it  over  with 
some  slight  comment.  But  we  reject  the  syllogistic  method,  as  being 
too  confused,  and  allowing  nature  to  escape  out  of  our  hands.  "  ^•■■'  '••' 
We  therefore  think  that  induction  is  the  true  method  which  guards 
our  senses  against  all  error,  which  clearly  follows  nature,  is  akin  to 
practice,  and  is  almost  practice  itself."  '••' 

Unfortunately,  it  is  not  the  form  of  argument,  not  the  logical  method, 
that  secures  a  man  from  false  reasoning.  Bacon  himself  furnishes  us 
the  proof  of  this  in  his  Organum — in  that  work,  even,  which  he  believed 
was  destined  to  direct  the  human  mind,  with  certainty,  toward  the 
truth.  In  fact,  after  having  exposed  his  method,  this  philosopher, 
desiring  to  show  its  application,  and  prove  its  excellence,  by  examples, 
essayed  to  resolve  by  it  several  problems,  one  of  the  first  of  which  I 
will  give  :  What  is  the  nature  of  heat '?  After  an  infinite  number  of 
exclusions  and  circumlocutions,  he  arrives  at  the  following  conclusion  : 
"  Heat  is  an  expansive  motion,  restrained,  and  striving  to  exert  itself, 
in  the  smaller  particles,  but  with  the  following  modifications  :  first,  by 
its  tendency  to  rise,  though  expanding  toward  the  exterior  ;  second,  this 
effort  is  modified  by  its  not  being  sluggish,  but  active,  and  somewhat 
violent."  f  I  leave  to  more  skilful  critics  the  task  of  explaining  this 
definition,  as  well  as  the  premises  from  which  it  is  derived  ;  but  I 
doubt  if  one  more  obscure  and  puzzling  can  be  found  among  those 
transmitted  to  us  from  antiquity. 

A  little  farther  on  the  same  author,  desiring  to  determine  the  nature 
of  tangible  bodies,  expresses  himself  thus  :  "  All  tangible  bodies  inclose 
an  invisible  and  intangible  spirit,  to  which  they  serve  as  envelope,  and 
as  clothing,  whence  result  three  orders,  or  modes  of  action,  which  are 
the  triple  source  of  the  powerful  effects  of  the  spirits  exerted  on  tangible 
bodies.  When  this  spirit  exhales,  the  body  contracts  and  dries ;  if  it 
is  retained,  it  softens  or  liquifies  it ;  finally,  if  it  is  neither  entirely 
emitted  nor  entirely  retained,  then  it  is  developed,  and  forms  the  mem- 
bers, assimilates,  evacuates,  and  organizes.  =•■-  =-••=  "  We  may  dis- 
tinguish three  species  or  modes  of  spirit,  namely,  the  unconnected 
spirit,  the  branching  spirit,  and  the  branching  and  cellular  spirit, 
or  the  one  which  is  ramified  and  distributed  in  different  cells  or  little 
cavities.     The  first  is  that  of  all  inanimate  bodies ;  the  second,  that  of 


"  The  Dignity  and  Advancement  of  Learning. 
I  Nov.  Organ. 


THEORIES   AND   SYSTEMS.  491 

vegetables ;  the  third,  that  of  animals."  This  is  not  as  obscure,  cer- 
tainly, as  the  definition  of  heat,  but  is  it  any  more  conformed  to  obser- 
vation '?  Does  not  the  author  surpass,  in  his  description  of  the  spirit 
of  tangible  bodies,  the  teaching  of  experience,  to  which  alone  he  should 
attach  himself? 

Induction,  as  we  see,  does  not  shelter  us  from  error  any  more  than 
syllogism,  and  the  merit  of  the  change  introduced  by  the  English  phi- 
losopher in  the  manner  of  cultivating  the  sciences,  does  not  consist,  as 
he  supposed,  and  as  many  others  after  him  did,  in  the  substitution  of 
the  inductive  for  the  syllogistic  form.  It  consists,  above  all,  in  the  \ 
emission  and  propagation  of  that  fundamental  truth  above  announced, 
that  from  sensations  and  particular  facts,  our  mind  must  not  spring,  at 
one  leap,  to  the  most  general  axioms,  but  that  it  must  gradually  rise 
from  particular  notions  transmitted  by  the  senses  to  ideas  more  and 
more  general.  This  single  proposition  contained  the  germ  of  the  whole 
philosophic  revolution ;  for,  from  the  moment  it  was  admitted  as  a 
principle,  that  the  first  ideas  which  are  formed  in  our  minds  are  partic- 
ular ideas,  related  to  individual  objects,  and  not,  very  general  ideas 
comprising  a  multitude  of  things,  the  whole  edifice  of  ancient  philo- 
sophy began  to  crumble  down,  and  it  was  necessary  to  reconstruct  it  on 
a  new  base,  viz.  :  the  careful  study  of  facts. 

Bacon  proposed  to  describe  all  the  forms  of  experience,  as  Aristotle 
had  described  all  the  forms  of  reasoning;  but  his  enterprise  has 
remained  more  defective  and  vain,  considered  as  a  whole,  than  that  of 
the  Greek  philosopher,  for  no  one  has  ever  made  use  of  the  logic  elab- 
orated by  Bacon,  while  that  of  Aristotle  was  employed  exclusively 
during  more  than  twenty  centuries,  and  is  still,  occasionally.  We  may 
judge  of  the  inextricable  confusion  which  reigns  in  the  work  of  the 
English  philosopher,  by  the  following  fragment,  which  forms  a  part  of 
the  conclusion:  "We  must  say,  in  conclusion,"  he  says,  "that  our 
Organum  is  only  a  simple  logic,  and  not  a  treatise  on  positive  philoso- 
phy. The  object  of  this  logic  is  to  direct  the  understanding,  and  to 
teach  it  not  to  hang  upon,  if  we  may  so  say,  vain  abstractions,  and  the 
pursuit  of  chimeras,  like  the  vulgar  logic,  but  to  grasp  nature,  and  to 
analyze  her — to  discover  the  true  properties  of  bodies,  the  real  and  well 
determined  actions  in  matter ;  in  a  word,  to  discover  a  science  which 
results  not  only  from  the  nature  of  the  mind,  but  also  from  the  nature 
of  the  things  themselves.  Therefore,  the  reader  must  not  be  astonished 
to  see  this  work  strewed  and  enriched  with  observations,  experiments, 
and  views  which  belong  to  the  science  of  nature,  and  which,  in  enlight- 
ening our  precepts,  serve  as  so  many  models  of  our  philosophic  course. 
Now,  these  prerogatives  of  facts  or  instances,  as  has  been  seen,  are 


492  REFORM   PERIOD. 

twenty-seven  in  number,  viz. :  soUtanj,  migrating,  ostensible,  clandes- 
tine, constitutive,  similar  and  singular ;  also,  instances  of  deviation, 
limitation,  poioers,  agreement,  and  hostility,  and  suhjunctions  ;  instances 
of  alliance,  of  the  cross,  of  divorce,  of  the  door,  citation,  carrying  for- 
ward, route  or  passage,  supplement,  dissection,  radiation,  course, 
doses  of  nature,  of  struggle  or  predominance,  of  indication,  of  those 
generally  useful,  and,  finally,  of  rnagicJ"'-'  Thus  Bacon,  after  having 
advanced  from  one  degree,  the  theory  of  Sensualism,  falls  into  chaos ; 
but  he  has.  nevertheless,  opened  t'le  route  and  indicated,  though  confus- 
edly, a  new  theory,  which  others  proceeded  to  study  and  elucidate  much 
better  than  he. 

John  Locke,  born  at  Wrington,  near  Bristol,  in  1G32,  six  years  after 
the  death  of  Bacon,  embraced  first  the  study  of  Medicine ;  but  the  del- 
icacy of  his  health  did  not  permit  him  to  practice  that  profession.  The 
reading  of  the  writings  of  11.  Descartes  awakened  in  him  a  taste  for 
philosophy.  However,  he  rejected  the  Cartesian  doctrine  on  innate 
ideas,  and  embraced  the  reripetecian  principles  renewed  by  Bacon — 
that  all  our  ideas  come  from  the  senses  and  from  reflection,  that  is  to 
say,  by  operations  of  the  mind,  or  the  comprehension  of  these  sensations. 
Here,  he  says,  are  the  only  two  sources  of  all  our  knowledge:  the 
impression  that  objects  make  on  our  senses,  and  the  proper  operations 
of  the  soul  concerning  these  impressions,  on  which  it  reflects  as  so  many 
veritable  objects  of  contemplation.!  Thus  proceeding  from  the  simple 
perception,  or,  in  other  words,  from  the  conscience  which  our  mind  has 
of  sensitive  impressions,  this  philosopher  conducts  us,  by  an  uninter- 
rupted gradation,  to  the  most  complex  and  abstract  operations  of 
thought.  He  shows  how  the  ideas  arise,  multiply,  arrange  and  connect 
themselves  in  our  understanding;  how  we  arrive  at  i-epresenting  these 
ideas  by  language ;  what  is  the  real  value  of  words  ;  what  are  the 
abuses  of  language,  and  into  what  errors  we  are  drawn,  by  the  habit  we 
early  contract,  of  considering  the  abstractions  of  our  minds  as  having 
an  existence  apart  from  us. 

Bacon  had  believed  and  taught,  that,  the  first  ideas  which  are  formed 
in  our  minds,  through  sensation,  must  be  particular  ideas,  related  to 
the  objects  or  individual  facts ;  he  had  protested,  energetically,  against 
the  plan  of  approaching  the  sciences  by  generalities,  or  axioms.  Locke, 
analyzing  with  a  rare  sagacity  the  functions  of  the  understanding,  from 
the  simplest  perception,  to  the  highest  abstractions,  demonstrated  what 
Bacon   had  only  asserted,  and  destroyed  without  attacking  it  directly, 

"Organ.  Nov.,  liv.  IT,  partii,  sec.  ii,  chap.  2,  §  in. 

•j-  Philosophic  Essay  on  the  Human  Understanding,  chap,  i,  §  24. 


THEORIES   AND   SYSTEMS.  493 

the  famous  sophism  of  Aristotle,  and  exhibited  in  a  style  as  neat  as  per- 
suasive, the  doctrine  of  Sensualism  or  Empiricism.  This  doctrine  made 
rapid  progress  in  England  and  in  France.  The  greatest  philosophers 
and  naturalists  of  these  two  countries,  during  the  eighteenth  century, 
adopted,  extended,  and  drew  from  it  consequences  more  or  less  legitimate. 
Stephen  Bonnat,  of  Condillac,  born  at  Grenoble,  the  thirtieth  of 
September,  1714,  (died  near  Beaugency,  third  of  August,  1780,)  was 
one  of  the  most  distinguished  representatives  of  this  philosophy.  He 
contributed  more  than  any  other  person  to  vulgarise  it,  by  simplifying  it 
still  more,  and  applying  it  to  all  the  sciences.  He  pretended  to  demon- 
strate that  all  our  knowledge  comes  from  our  sensation ;  or,  in  other 
words,  is  nothing  else  than  sensations  transformed.  He  reduced  all 
the  rules  of  reasoning  to  a  single  one,  identity  in  propositions,  and 
wished,  also,  to  bring  back  all  modes  of  acquisition  and  demonstration 
to  one  only,  analysis.  The  writings  of  this  philosopher  having  become 
classic,  in  France,  we  proceed  to  extract  from  them  some  general 
maxims,  now  admitted  as  incontestable  rules  in  the  "sciences  devoted 
to  sensible  objects,  such  as  physics,  chemistry,  natural  history,  and 
medicine. 


APHORISMS    OF     PHILOSOPHY,    PARTICULARLY    APPLICABLE    TO    THE     PHYSICAL 

SCIENCES.- 

I.  The  ideas  we  form  from  sensible  objects,  are,  in  their  origin,  but 
the  consciousness  of  impressions  which  these  objects  make  upon  our 
senses:  now,  as  there  are  in  nature  only  individuals,  it  necessarily 
follows,  that  we  have,  in  principle,  only  individual  ideas — ideas  that 
are  related  to  such  and  such  an  object. 

II.  We  have  not  imagined  names  for  each  individual ;  we  have 
only  distributed  the  beings  in  different  classes,  which  we  distinguish  by 
particular  names,  and  those  classes  are  what  are  termed  genera,  species. 

III.  To  form  a  class  of  certain  objects,  is,  then,  nothing  more  than 
to  give  a  common  name  to  all  those  we  judge  to  be  similar.  But  we 
would  strangely  deceive  ourselves,  if  we  imagined  that  there  are,  in 
nature,  species  and  genera,  because  there  are  species  and  genera  in  our 
manner  of  viewing  her. 

IV.  The  more  our  discernment  is  perfected,  the  more  the  classes 
will  be  multiplied,  because  there  are  no  two  individuals  who  do  not 
differ  in  some  particulars.     But,  if  it  is  important  to  make  distinctions, 

^The  exclusive  partisans  of  the  Sensualist  doctrine  derive  from  the  same  source, 
moral  and  metaphysical  truths  ;  but  the  legitimacy  of  this  derivation  is  warmly 
contested  by  other  philosophers. 


494  REFORM   PERIOD. 

it  is,  perhaps,  more  important  not  to  make  too  many  of  them.  Do  you 
desire  to  know  within  what  limits  wc  may  divide  and  sub-divide  our 
ideas  ?  I  reply,  or  rather,  nature  replies  for  me,  until  we  have  enough 
classes  to  guide  us  in  the  use  of  things  relative  to  our  wants. 

V.  Sensible  objects  being  known  to  us  only  by  the  impressions  they 
make  on  our  senses,  our  minds  perceive  nothing  in  the  objects  beyond 
the  sensations  they  excite.  Thus,  when  we  are  asked  what  is  the 
nature  or  essense  of  a  body,  we  are  only  able  to  respond  by  announcing 
the  sensible  qualities  of  that  body. 

VI.  All  the  qualities  of  a  being,  considered  in  itself,  are  equally 
essential,  for  they  all  appertain  to  its  nature  and  its  essence ;  but  they 
are  not  all  equally  essential,  in  relation  to  us,  and  the  abstract  idea 
which  we  have  formed  of  that  being  ;  so  that,  what  is  termed  essential, 
or  non-essential,  in  any  thing,  is  only  so,  relatively,  to  our  ideas. 

These  aphorisms  may,  henceforth,  be  considered  immutable ;  for  they 
not  only  flow  from  the  theory  of  sensualism,  but  they  are  also  confirmed 
by  the  sectators  of  a  philosophic  doctrine  opposite  to  this,  as  we  shall 
see  in  the  following  paragraph.  But,  beforehand,  it  is  necessary  that 
we  refute  two  errors  propagated  by  the  authority  of  Condillac,  errors 
strongly  accredited,  in  the  schools  of  philosophy,  and  which  are  only 
calculated  to  retard  the  progress  of  the  science  of  observation. 

FIRST      PARADOX. 

The  art  of  reasoning,  says  Condillac,  may  be  reduced  to  a  well- 
formed  language ;  and,  all  sciences  would  be  exact  if  they  employed  a 
simple  language. 

This  celebrated  ideologist  supports  this  proposition  by  a  very  spe- 
cious argumentation,  founded,  principally,  on  the  certainty  and  facility 
of  reasoning  in  mathematics ;  advantages  which  he  attributes  to  the 
perfection  of  algebraic  language.  He  cites,  in  point,  the  following 
problem:  "If  a  man  holding  'counters'  in  both  of  his  hands,  passes 
one  from  the  right  to  the  left,  the  number  of  counters  is  alike  in  both ; 
if,  on  the  contrary,  he  passes  one  counter  from  the  left  hand  to  the 
right,  he  has  double  as  many  counters  in  the  right  one ;  the  question 
is,  how  many  counters  had  he,  at  first,  in  each  hand?  Condillac 
in  the  first  place  resolves  this  problem  in  common  language ;  then  he 
shows  how  much  more  easy  it  is  to  obtain  its  solution,  when  the  problem 
is  translated  into  algebraic  language.  Hence  he  concludes,  that  if 
the  sciences  are  but  slightly  inexact,  it  is  only  because  their  vocabu- 
laries are  badly  formed ;  a  defect  which  is  not  usually  perceived,  or 
which  we  do  not  know  how  to  correct."  "  Must  we  be  astonished,"  he 
exclaims,  "  that  men  cannot  reason,  when  the  language  of  the  sciences 


THEORIES  AND   SYSTEMS.  495 

is  only  a  jargon,  composed  of  too  many  words,  some  of  whicli  are 
common,  with  no  determined  meaning,  and  others  are  foreign  or  barba- 
rous ones,  and  not  well  understood  ?  All  sciences  would  be  exact  if  we 
knew  how  to  speak  their  respective  languages." 

It  seems  from  this  argument  that  .the  exactness  of  the  sciences 
reduces  itself  to  the  work  of  the  grammarian,  which  is  a  paradox  unsus- 
tainable, and  falls  before  the  investigation  of  good  common  sense.  Who 
will  dare  affirm  that  the  modern  progress  of  physics,  chemistry,  natural 
history,  etc.,  are  due,  entirely,  or  even  principally,  to  mere  modifications 
introduced  into  the  language  of  these  sciences  ?  Who  does  not  know, 
on  the  contrary,  that  this  progress  is  almost  exclusively  the  result  of  ob- 
servation and  of  experiment  ?  Do  we  not  see  every  day,  that  men  almost, 
or  entirely  unlettered,  make  discoveries  that  have  escaped  the  learned? 

The  proposition  of  the  French  metaphysician  is  false,  even  in  relation 
to  mathematics ;  it  is  not  true  that  algebraic  language  has  given  to  the 
reasonings  of  mathematicians  more  certainty  or  conviction ;  their 
reasonings  were  as  infallible  before  the  introduction  of  algebra  as  since, 
only  they  were  less  prompt,  less  easy,  and  less  general.  The  Komans, 
with  their  very  defective  figures,  calculated  everything  as  exactly  as  the 
Arabs,  whose  figures  are  much  move  perfect ;  but  they  calculated  less 
rapidly  and  less  conveniently. 

Therefore,  if  Condillac  had  limited  himself  to  saying  that  the  per- 
fection of  the  language  adds  much  to  the  clearness,  facility  and  power 
of  reasoning,  and  consequently  notably  to  the  progress  of  science,  he 
would  have  been  correct ;  but  he  surpasses,  evidently,  the  limits  of 
truth,  when  he  affirms  that  all  the  sciences  would  be  exact  if  they  were 
expressed  in  appropriate  language.  He  takes,  in  this  respect,  the 
shadow  for  the  substance — the  image  for  the  reality ;  and,  by  this 
mistake,  he  diverts,  so  far  as  he  is  followed,  the  human  mind  from  the 
route  which  leads  to  discoveries  in  the  science  of  observation.  The 
proposition  of  Condillac  would  be  more  exact  if  it  was  reversed ;  so  that 
it  might  be  said  without  being  paradoxical,  that  the  more  a  science 
approaches  exactness  or  truth,  the  more  its  language  acquires  perfec- 
tion ;  which  reminds  us  of  this  axiom  of  the  legislator  of  the  French 
Parnassus : 

Ce  que  I'on  concoit  bien  s'edonce  clairement, 
Et  les  mots,  pour  le  dire,  arrivent  aisement." 

Thus,  the  poet  shows  himself  a  more  profound  thinker  than  the 
philosopher. 

^■'  What  is  well  conceived  is  announced  clearly, 
And  the  words  to  utter  it  flow  easily. 


496  REFORM   PERIOD. 


SECOND     PARADOX. 

Analysis  is  the  sole  method  for  the  acquisition  of  knowledge.  Such 
is  the  proposition  of  Condillac,  developed  in  several  chapters,  which  he 
strives  to  establish  by  an  argument  that  he  believes  irrefutable.  We 
will  now  see  how  far  he  has  succeeded. 

According  to  this  philosopher,  analysis  consists  in  decomposing,  in 
the  first  place,  the  object  which  it  is  desired  to  comprehend,  in  order  to 
study  separately  each  of  its  parts  or  qualities,  as  well  as  their  mutual 
relations ;  afterward,  to  connect  all  these  qualities  or  parts  in  their 
natural  order,  so  as  to  contemplate  the  same  object  as  a  whole.  He 
cites,  in  this  view,  the  following  example:  "I  will  suppose,"  he  says, 
"  a  castle  which  overlooks  a  vast  and  fertile  domain,  where  nature  has 
been  pleased  to  spread  a  great  variety,  and  where  art  has  availed  itself 
of  these  natural  advantages,  to  embellish  it  still  more.  We  reach  the 
chateau  during  the  night ;  the  next  day  the  windows  are  opened,  just  at 
the  moment  when  the  sun  begins  to  gild  the  horizon,  and  in  an  instant 
afterward  they  are  closed  again.  Although  the  scenery  was  exhibited 
to  us  but  for  one  moment,  we  have  certainly  had  a  view  of  the  whole. 
But  this  first  sight  does  not  suffice  to  make  us  acquainted  with  it — in 
other  words,  to  look  separately  at  the  objects  it  contains,  and  therefore, 
it  would  be  impossible  for  us,  when  the  windows  are  closed,  to  give  an 
account  of  what  we  have  seen.  This  illustrates  how  we  may  see  many 
things'  without  learning  anything. 

"  Finally  the  windows  are  opened  again,  not  to  be  closed  as  long  as 
the  sun  is  above  the  horizon,  and  we  see  again,  for  along  time,  what  we 
saw  before.  But  if,  like  men  in  extacy,  we  contemplate  all  at  once  the 
great  multitude  of  difi'erent  objects  before  us,  we  shall  know  no  more 
when  the  night  comes  than  we  knew  after  the  first  glance  we  obtained 
of  them  in  the  morning.  To  get  a  clear  knowledge  of  that  scene,  it  will 
not  suflice,  then,  to  look  at  every  part  at  once — the  parts  must  be 
studied  in  succession  ;  and,  instead  of  embracing  the  whole  in  a  single 
coiip  iVoeil,  it  is  necessary  to  pass  successively  from  one  object  to 
another.  This  is  what  nature  teaches  all  of  us.  We  commence,  then,  by 
the  principal  objects  ;  we  observe  them  successively,  and  compare  them,  in 
order  to  judge  of  their  relations  to  each  other.  When,  by  this  means, 
we  have  recognised  their  respective  situations,  we  observe,  progressively, 
all  those  that  fill  up  the  intervals,  or  compare  each  one  with  the  nearest 
principal  object,  and  determine  from  this,  its  position.  Then,  only,  we 
separate  all  the  objects  wliose  form  and  situation  have  been  compre- 
hended, and  embrace  them  all  in  a  single  view. 


THEORIES   AND    SYSTEMS.  497 

"  If,  now,  we  reflect  on  the  manner  in  which  we  acquire  knowledge 
by  sight,  we  remark  that  any  very  complicated  object,  such  as  a  vast 
landscape,  is,  so  to  say,  decomposed,  since  we  comprehend  it  only  if  its 
parts  have  presented  themselves  one  after  another,  to  arrange  themselves 
in  regular  order  in  our  minds.  We  have  shown  in  what  order  this 
analysis  takes  place.  The  principal  objects  first  strike  our  minds,  then 
the  others  follow,  and  arrange  themselves  according  to  the  relations  they 
bear  to  the  first.  We  make  this  mental  analysis,  only  because  an 
instant  is  not  sufficient  for  the  study  of  all  these  objects ;  but  we 
decompose,  merely  to  reconstruct ;  and  when  the  knowledge  of  the  whole 
is  acfjuired,  its  parts,  instead  of  being  successive,  have  in  the  mind  the 
same  simultaneous  order  which  they  possess  in  reality.  In  this  simul- 
taneous order,  consists  the  knowledge  which  we  possess  of  them,  for  if 
we  could  not  recall  them  as  a  whole,  we  would  never  be  able  to  conceive 
the  relations  which  they  have  among  themselves,  and  we  would  have, 
therefore,  but  an  imperfect  knowledge  of  the  objects." 

If  analysis  consists,  as  Condillac  pretends,  in  decomposing  an  object 
into  its  elements,  and  at  once  recomposing  it,  what  then  is  synthesis  ? 
The  response  to  this  question  seems  to  me  difficult ;  I  seek  in  vain  for  it 
in  the  writings  of  that  philosopher ;  I  find  nothing  there  clear  and 
satisfactory.  "  Synthesis,"  he  says,  "  is  a  dubious  method,  which 
commences,  always,  where  it  ought  to  end.  I  cannot  give  a  more  precise 
notion  of  it,  either  because  I  do  not  comprehend  it,  or  because  it  is  not 
possible  to  do  so.  It  escapes  examination  because  it  assumes  the 
mental  characteristics  of  all  those  who  emploj^  it,  and  especially  of 
illogical  minds."  " 

P.  J.  Barthez,  of  whom  we  shall  speak  at  length  hereafter,  has 
better  comprehended  and  defined  synthesis ;  though  he  has  but  briefly 
alluded  to  it.  He  expresses  himself  on  the  subject  as  follows  :  "  Con- 
dUlac,  in  what  he  has  said  on  analysis,  in  various  places  in  his  Art 
of  Thinking,  gives  what  he  terms  analysis,  so  extended  a  sense  that  it 
includes,  also,  synthesis,  or  the  recomposition  of  analysed  objects.  The 
denomination  of  the  analytic  method  becomes,  then,  so  vague  that  it 
may  be  said  that  analysis  is  employed  in  all  the  operations  by  which 
any  discovery  is  made  in  natural  philosophy.  The  method  which 
Condillac  terms  analysis,  has  nothing  in  it  truly  analytic,  except  the 
decomposition  which  is  made  at  first  of  the  cpalities  or  elements  of  the 
object  to  be  studied."  f 

^  Logique,  part  ii.,  chap.  vi. 

fNouveaux  Elements  de  la  Science  de  I'Homme.  Paris,  1806,  Preliminary 
Discourse,  sect,  i.,  note  iv. 


498  REFORM    PERIOD. 

This  passage  of  Bartliez  is  very  important ;  for  it  not  only  sliows 
us  in  what  synthesis  consists,  but  also  why  Condillac  is  embarrassed 
when  speaking  of  that  method.  It  is  clear,  that  this  metaphysician, 
having  comprised  under  the  name  of  analytical  method,  both  analysis 
and  synthesis,  that  is  to  say,  the  decomposition  and  reconstruction  of 
the  object  under  consideration,  there  remains  nothing  for  him  to  say, 
when  he  wishes  to  define  the  synthetic  method ;  for  this  reason  he 
indulges  in  pure  declamations. 

Synthesis,  according  to  Barthez,  and  according  to  the  etymology  of 
the  word,  consists,  then,  in  the  reconstruction  of  the  object  which  has 
been  decomposed  by  analysis  ;  it  is  the  necessary  complement  of  analysis, 
and  its  proof.  Thus,  when  a  chemist  has  decomposed  a  substance — a 
mineral  water,  for  example — and  when  he  has  studied  all  its  elements 
separately,  he  should  afterward  reunite  them,  so  as  to  reconstitute,  if 
possible,  the  primitive  substance,  in  its  natural  state.  It  is  only  after 
reproducing,  by  synthesis,  the  natural  compound,  that  one  is  sure  of 
the  exactness  of  his  analysis.  The  following  is  a  brilliant  example  of 
the  satisfaction  received  by  the  mind  by  the  alliance  of  synthesis  with 
analysis  :  If  a  solar  ray  is  permitted  to  penetrate  a  darkened  room,  and 
is  received  on  a  prism  of  triangular  crystal,  this  ray  forms,  on  the 
opposite  wall,  an  elongated,  finely-colored  image,  with  all  shades,  from 
red  to  violet.  Then,  if  a  thin  board,  pierced  with  seven  holes,  be 
interposed  between  the  prism  and  the  image,  termed  the  solar  spec- 
trum, there  appear,  behind  this  diaphragm,  seven  circular  images, 
presenting  the  red,  the  orange,  the  yellow,  the  green,  the  blue,  the 
indigo,  and  the  violet.  To  be  assured  that  these  seven  colors,  thus 
obtained,  are,  in  fact,  the  constituent  parts  of  the  luminous  ray,  all  of 
them  may  be  converged  on  the  same  surface,  by  means  of  reflecting 
mirrors,  in  such  a  way  that  white  light  is  produced  again. 

I  agree  with  Condillac,  that  synthesis  united  to  analysis,  is  the  best, 
yea,  the  only  method,  to  acquire  exact  notions  of  nature  ;  and  this 
metaphysician  was  only  wrong  in  confounding,  under  a  single  denomi- 
nation two  different  things  ;  but  this  mistake  draws  him  into  more  than 
one  error.  When  he  advances,  for  example,  that  the  ancients,  Aristotle 
among  others,  did  not  know  analysis,  he  is  strangely  deceived  ;  for  not 
only  did  Aristotle  employ,  frequently,  the  analytic  method,  but  he  also 
greatly  abused  it.  The  reproach  which,  rather,  should  be  made  to  the 
philosopher  of  Stagyrus,  and  to  all  the  physicians  of  antiquity,  is,  not 
to  have  verified  the  results  of  their  analysis  by  synthesis  ;  or  for  having 
been  contented  with  a  mental  analysis,  where  they  should  have  employed 
a  material  one.  Thus,  when  they  affirmed  that  all  bodies  were  formed 
of  four  elements — fire,  air,  earth,  and  water — they  should  have  been 


THEORIES   AND   SYSTEMS.  499 

able  to  prove,  materially,  the  existence  of  these  four  elements  in  each 
body,  and  reconstruct  again  the  body,  by  bringing  together  its  con- 
stituent elements/-' 

I  have  dwelt  somewhat  at  length  on  the  errors  of  Condillac,  in  regard 
to  the  analytic  method,  and  the  influence  of  language ;  because  the 
doctrine  of  this  philosopher  reigned  almost  exclusively,  in  France, 
during  the  last  half  of  the  eighteenth  century,  and  the  beginning  of 
the  nineteenth,  and  because  it  is  still  predominant,  and  is  very  seduc- 
tive, by  its  clearness,  simplicity,  and  the  logic  of  its  deductions  ;  hence 
results  the  necessity  of  guarding  the  public  against  the  illusions  which 
it  has  a  tendency  to  foster. 


§  ni.    On  Rationalism,  and  Reasoning  by  Deduction. 

In  reasoning  by  induction  our  minds  associate  a  quantity  of  particular 
facts,  united  together  by  certain  analogies,  and  draw  from  their  relation 
a  more  or  less  general  conclusion.  Example  :  put  carbonate  of  potassa 
into  water,  it  is  dissolved  ;  put  into  the  same  fluid  a  sulphate,  a  nitrate, 
in  a  word,  any  salt,  with  potash  as  a  base,  and  all  will  be  dissolved. 
From  the  sesuccessive  experiments,  sufficiently  often  repeated,  you  will 
be  right  in  drawing  the  general  conclusion,  that  all  the  salts  of  potassa 
are  soluble  in  water. 

In  reasoning  by  deduction,  on  the  contrary,  we  proceed  to  draw  from 
one  fact,  or  a  simple  proposition,  a  series  of  propositions,  which  follow 
each  other  so  logically  that  they  seem  to  flow  from  the  first,  as  a  com- 
mon source.  Example  :  a  triangle  is  a  surface  bounded  by  three  right 
lines.  From  this  definition  the  geometricians  are  able  to  deduce  a  gi'eat 
number  of  curious  and  useful  theorems. 

Eeasoning  by  induction,  and  reasoning  by  deduction,  or,  if  you  please, 
the  inductive  and  deductive  methods,  have  each  their  particular  advan- 
tages and  inconveniences,  which  render  them  more  or  less  valuable  in 
difi'erent  sciences.  Natural  philosophers,  chemists,  and  physicians  pre- 
fer the  inductive  method,  and  draw  from  it  excellent  practical  rules ; 


"  We  have  seen,  in  one  of  the  Hippocratic  books,  a  commencement  of  the 
material  proof  of  the  existence  of  the  four  elements.  The  author  of  the  book 
cites  the  example  of  the  results  in  burning  green  wood:  he  saw  the  igneous 
element  in  the  flame ;  the  aerian  element  in  the  gas,  that  sometimes  escapes 
with  i\oise ;  the  aqueous  element  in  the  water  which  stews  out,  and,  lastly,  the 
terrestial  element  in  the  ash  or  residuum.  But  this  gross  attempt  at  chemical 
analysis  lacked  the  proof  of  synthesis.  Besides  this,  the  author  commits  the 
common  error  of  inferring  general  from  particular  facts. 


500  REFORM   PERIOD. 

but  they  should  not  forget  that  a  single  experiment  hadly  made,  or 
omitted,  suflBces  to  vitiate  a  general  conclusion.  The  metaphysicians, 
moralists  and  mathematicians  reason  nearly  always  by  deduction  and 
we  are  indebted  to  this  method  for  the  finest  precepts  in  morals  and 
natural  religion,  the  base  of  all  society  ;  we  owe  to  it,  also,  the  inven- 
tion and  perfection  of  mathematics.  But  it  must  not  be  forgotten  that 
if  the  primitive  proposition  is  not  of  incontestable  certainty,  or  if  the 
least  error,  or  the  slightest  omission  occurs  in  the  propositions  which 
follow,  the  entire  structure  falls. 

Eene  Descartes,  born  at  Hague,  in  Touraine,  in  1596,  exhibited  in 
early  life  an  independent  and  creative  genius.  He  had  already  dis- 
tinguished himself  by  important  discoveries  in  physics,  astronomy,  and 
especially  in  mathematics,  when  he  undertook  to  effect,  by  the  method 
of  abstract  reasoning,  in  opposition  to  that  of  Empiricism,  a  reform  in 
philosophy,  an  enterprise  whose  results  were  brilliant  and  immense,  and 
which  created,  says  the  historian  of  philosophy,  Tenneman,  admiration 
as  well  as  a  very  lively  opposition.  Descartes  commenced,  like  Aris- 
totle and  Bacon,  by  ignoring  all  existing  knowledge.  "To  attain  the 
truth,"  he  says,  "  it  is  necessary  to  free  ourselves  at  one  time  in  our 
lives,  from  all  the  opinions  which  we  have  previously  acquired,  and 
reconstruct  anew  from  the  foundation  the  whole  system  of  knowledge."! 
This  precept,  old  though  it  was,  appeared  as  a  bold  novelty,  and  made 
a  great  noise  in  the  learned  world,  to  such  an  extent  had  they  lost  the 
habit  of  the  methodic  doubt,  particularly  in  philosophy. 

This  fearless  metaphysician  did  not  limit  here  his  reform  in  regard  to 
method ;  he  overthrew,  with  a  single  stroke,  the  whole  framework  of 
the  Peripatecian  logic  so  subtily  elaborated  by  Aristotle,  that  pedantic 
apparatus  capable  of  retarding  the  advancement  of  the  human  mind, 
but  unable  to  prevent  it  from  falling  or  going  astray.  "  In  my  exam- 
ination," he  says,  "I  observed  that  logic,  its  syllogisms,  and  the 
greater  part  of  its  teachings  serve,  at  most,  to  explain  to  others  things 
which  they  already  know,  or  yet,  like  the  art  of  E.  Lulle,  to  speak 
without  judgment  of  those  things  of  which  they  are  ignorant,  rather 
than  to  teach  them."*  He  replaces  this  complicated  logic  by  a  simple 
and  sure  rule,  of  which  the  following  is  the  substance :  the  mind  may 
affirm  of  a  thing  all  that  is  embraced  in  the  idea  of  that  thing,  or, 
evidence  is  the  only  certainty  of  the  truth  of  our  judgment.  1 

*"'  This  sentence  is  repeated  in  various  ways,  in  numerous  passages  of  his 
writings. 

f  Discours  sur  la  Methode. 

J  Condillac  has  defined  this  rule  more  clearly  by  showing  that  evidence  consists 
in  the  identity  of  the  propositions  which  follow  each  other. 


THEORIES   AND   SYSTEMS.  501 

Having  thus  cleared  the  ground  from  every  species  of  prejudice,  and 
having  created  a  method  easy  for  the  arrangement  of  the  materials  of 
thought,  Descartes  attempts  to  rebuild  the  edifice  of  human  knowledge, 
by  starting  from  the  phenomenon  of  consciousness :  /  think,  from  which 
he  draws,  at  once,  this  consequence:  therefore,  I  exist.  From  this  he 
rises,  by  a  series  of  deductions,  to  the  most  sublime  moral  truths ;  but 
I  shall  not  follow  him  in  this  region,  because  it  does  not  belong  to  my 
subject,  and,  therefore,  I  pass,  at  once,  to  the  physical  phenomena, 
Descartes  takes,  as  the  basis  of  his  cosmogony,  this  proposition  of  the 
Pythagorean  philosophy :  matter  is  inert,  and  has,  of  itself,  no  form  or 
energy.  It  is  possible,  that,  at  bottom,  this  principle  is  true  ;  but,  if 
we  consult  observation,  which  must  be  the  point  of  departure  of  all 
reasoning  in  physics,  we  shall  agree  that  it  proves  the  contrary  of  the 
Cartesian  principle.  Up  to  this  time,  chemistry  has  not  been  able  to 
discover  any  matter  absolutely  inert ;  that  is  to  say,  matter  deprived 
of  properties,  and  susceptible  to  acquire  all  those  which  it  might  be 
desirable  to  give  it ;  for,  this  would  be  the  philosopher's  stone,  the 
primitive  matter  so  much  sought  after  by  the  alchymists. 

The  illustrious  philosopher  of  Touraine  has  placed  himself,  from  the 
first,  outside  of  the  real  world ;  1  shall  not,  therefore,  follow  him  in 
his  brilliant  fictions,  but  shall  content  myself  here,  in  offering  to  my 
readers,  a  small  part  of  his  physiology,  to  show  how  little  it  is  con- 
formed to  observation:  '•!  assume,"  he  says,  '"that  the  body  is 
nothing  more  than  a  statue  or  machine  of  earth,  which  God  forms 
expressly  to  make  it  as  similar  to  us  as  possible.  Thus  he  gives  to  it, 
externally,  not  only  the  color  and  the  shape  of  all  our  members,  but, 
also,  he  puts  within  it  all  the  parts  which  are  re(|uisite,  to  enable  it  to 
move,  eat,  respire,  and,  in  short,  that  it  be  able  to  imitate  all  of  these 
functions,  which  may  be  imagined  to  proceed  from  matter,  and  to 
depend  only  on  the  disposition  of  the  organs."---' 

Beliold  a  machine  perfectly  organized,  possessing  all  the  material 
conditions  for  the  exercise  of  its  functions,  but  which,  nevertheless, 
according  to  our  physiologist,  accomplishes  none.  This  hypothesis  is 
also  in  opposition  to  daily  observation  and  common  sense.  When  a 
child  is  born,  well-formed,  that  is  to  say,  with  all  the  apparent  condi- 
tions necessary  to  life,  we  cannot  conceive  that  it  does  not  live  ;  and,  if 
by  accident  it  is  dead-born,  we  are  always  moved  to  ask,  why  it  is 
dead,  or  in  other  words,  what  is  the  material  obstacle  which  prevented 
it  from  living?  Let  us  follow,  however,  the  hypothesis  of  Descartes, 
to  see  where  it  will  lead  us. 

^  Partie  philosopMque  des  Traite  de  1'  Homme. 


602  REFORM   PERIOD. 

"  If  you  have  ever  Lad  the  curiosity  to  observe  the  organs  in  our 
churches,  you  know  how  the  bellows  forces  the  air  into  certain  recep- 
tacles, which,  I  think,  are  named  air-chambers ;  and  how  this  air 
enters  into  the  different  pipes,  accordingly  as  the  organist  touches  the 
keys  of  the  instrument.  Now  you  are  able  to  conceive,  that  the  heart 
and  arteries,  which  force  the  animal  spirits  into  the  cavities  of  the  brain 
of  our  machine,  act  like  the  bellows  of  the  organ,  which  force  the  air 
into  the  air-chambers ;  and,  that,  exterior  objects  acting  upon  the 
nerves  which  they  excite,  cause  the  spirits  contained  in  these  cavities, 
to  pass  from  them  into  some  of  the  pores,  and  thus  resemble  the  fingers 
of  the  organist,  who,  according  to  the  key  which  he  touches,  makes  the 
air  enter  from  the  air-chambers  into  some  of  the  pipes.  Now,  as 
the  harmony  of  organs  does  not  depend  on  the  arrangement  of  their 
pipes  which  are  visible,  nor  upon  the  shape  of  their  air-chambers  or 
other  parts,  but  solely  upon  three  things,  viz.,  the  air  which  comes 
from  the  bellows,  the  pipes  that  give  sounds,  and  the  distribution  of 
the  air  in  those  pipes :  so,  also,  I  assume,  that  the  bodily  functions  in 
question,  do  not  at  all  depend  on  the  external  shape  of  the  visible 
parts  which  the  anatomists  distinguish  in  the  substance  of  the  brain, 
nor  upon  that  of  the  cavities,  but  solely  upon  the  spirits  which  came 
from  the  heart,  the  pores  of  the  brain  through  which  they  pass,  and 
the  manner  in  which  these  spirits  are  distributed  in  these  pores,  so  that 
it  is  only  required  of  me  to  explain  here,  in  order,  all  that  there  is 
most  important  in  regard  to  these  three  things.  "=•••= 

The  tendency  of  our  philosopher  to  throw  himself  outside  of  sensible 
phenomena  is  here  still  striking.  Three  things  appear  to  him  only 
necessary  in  the  study  of  physical  man,  namely :  the  spirits  that  come 
from  the  heart,  the  pores  of  the  brain  which  give  them  passage,  and 
the  manner  in  which  these  spirits  distribute  themselves  in  the  pores  ; 
now,  not  one  of  these  three  things  is  tangible.  On  the  other  hand,  he 
annihilates  completely  the  study  of  anatomy,  in  affirming  that  the  play 
of  the  human  organs  does  not  depend  at  all  on  their  external  conforma- 
tion. I  doubt  if  many  naturalists  and  physicians  would  subscribe  to 
such  a  doctrine.  This  example  shows  us  how  dangerous  it  is  to  attempt 
the  explanation  of  physical  phenomena  by  means  of  pure  thought ;  for 
the  method  preferred  by  speculative  minds  conducts  us  almost  inevita- 
bly into  the  imaginary  world,  and  causes  us  to  loose  sight  of  observa- 
tion and  reality.  To  go  back  to  the  primordial  fact  of  our  existence, 
and  from  that  fact  deduce  all  the  others  by  a  rigorous  chain  of  propo- 
sitions :  such  has  been,  in  all  times,  the  utopia  of  strong  imaginations, 

'■•■"  Partie  philosophique  des  Traite  de  V  Homme. 


THEORIES   AND   SYSTEMS.  503 

and  men  of  transcendental  genius.  Many  great  minds,  before  and  since 
Descartes,  have  failed  in  the  enterprise,  and  many  more  will  yet  fail. 
But  Descartes  has  rendered  an  eminent  service  to  philosophy  iu  ridding 
it  of  its  scholastic  apparel,  and  replacing  all  the  rules,  so  complicated 
of  Peripatetic  logic,  by  a  single  safe  and  easy  rule. 

Leibnitz,  a  universal  genius,  and  eminently  a  generaliser,  who  shares 
with  Xewton  the  glory  of  having  invented  the  differential  calculus, 
conceived,  from  his  sixteenth  year,  the  project  of  a  universal  alphabet, 
which  would  represent  all  possible  shades  of  thought,  with  the  same 
precision  and  the  same  generality  as  the  algebraic  characters  represent 
the  relations  of  numbers.  "It  is  only  requisite,"  he  says,  "to  find 
certain  terms  or  forms  with  which  to  announce  metaphysical  propositions, 
which  terms  could  serve  as  a  guide  in  this  labyrinth,  in  order  to  resolve 
the  most  complicated  questions  by  a  method  similar  to  that  of  Euclid, 
preserving  always  that  clearness,  or  that  distinctness  of  ideas  which 
the  vague  and  undetermined  signs  of  our  common  languages  do  not  per- 
mit." He  dreamed  all  his  life  of  this  great  problem,  and  died  without 
having  found  its  solution,  though  convinced  of  the  possibility  of  arriving 
at  it."  Descartes  had,  also,  this  conviction,  for  he  wrote  in  one  of  his 
letters :  "  Ideological  characters  might  be  invented  to  express  all 
thoughts,  as  has  already  been  done  for  arithmetic  and  music  ;  but  to 
do  this,  it  would  be  necessary  to  analyze  all  simple  ideas,  and  apply  to 
them  signs  which  would  imitate,  in  their  combinations,  those  of  our 
thoughts." f  These  two  great  men  then  imagined  that,  by  perfecting  the 
language  of  metaphysics,  the  same  precision  could  be  given  to  this  sci- 
ence as  is  given  to  mathematics.  In  this  they  committed  an  error, 
which  Condillac  renewed  at  a  later  period,  though  he  adopted  a  philo- 
sophic method  wholly  contrary — an  error  which  we  have  already  suffi- 
ciently refuted.  I 

Leibnitz,  knowing  the  objections  which  had  been  raised  against  the 
system  of  Descartes,  and  the  singular  consequences  which  had  been 
deduced  from  it,  by  the  spiritualist,  Malebranche,  on  one  hand,  and  the 
materialist,  Spinosa,  on  the  other,  thought  to  guard  himself  from  these 
various  difficulties  by  choosing  for  the  basis  of  his  cosmological  theory, 

"''Works  of  Leibnitz,  v.  ii,  p.  49.  Historia  et Commendatio Liiiguaa  Caracteris- 
tise  Universalis,  p.  535. 

f  Letter  46. 

T  Godfrey  William  Leibnitz  was  born  at  Leipsic,  in  1646,  or  four  years  after 
the  birth  of  Newton.  He  was,  incomparably,  says  Cuvier,  the  most  encyclopedic 
mind  that  has  appeared  since  Aristotle. 


504  REFORM   PERIOD. 

a  hypothesis  diametrically  opposite  to  that  of  the  French  philosopher. 
This  latter  had  started  with  the  generally  received  opinion  of  his  time, 
that  matter  is  homogeneous  and  completely  inert;  the  German  2)hiloso- 
pher  took,  as  a  point  of  departure,  the  observed  fact,  that  there  only 
exist  in  nature  individual  baings,  and  that  each  individual  differs  from 
all  others  in  some  particulars.  To  explain  this  diversity,  he  supposes 
that  the  germs  of  all  living  beings  having  been  created  from  all  eternity, 
never  perish ;  that  they  only  enlarge  and  become  visible,  when  we  say 
that  they  are  born  ;  and  that  they  only  diminish  and  cease  to  be  appa- 
rent, when  we  suppose  that  they  die.  He  gives  to  these  imperceptible 
and  invisible  germs  the  name  of  monads.  He  developes  his  hypothesis 
as  follows : 

"  Very  exact  experimenters  have  already  perceived  in  our  time,  that 
it  may  be  doubted  if  an  entirely  new  species  of  animal  is  ever  produced, 
and  if  all  animals  are  not  already  living  in  a  minute  state  before  con- 
ception, in  the  semen  of  animals,  as  plants  are  in  their  seed.  This  doc- 
trine being  accepted,  it  would  be  reasonable  to  suppose  that  what  has 
no  commencement  of  life,  has  also  no  ending  of  it,  and  that  death,  like 
generation,  is  only  the  transformation  of  the  same  animal,  which  is 
sometimes  augmented,  and  sometimes  diminished.  What  oj)ens  to  us, 
still,  the  marvels  of  the  divine  artifice  which  no  one  has  ever  supposed 
is,  that  the  machines  of  nature,  being  machines  even  to  their  most 
minute  parts,  are  indestructible,  on  account  of  their  enclosing  a  little 
machine  in  a  greater  one,  ad  infinitum.  Thus,  we  find  ourselves  obliged 
to  accept,  at  .the  same  time,  the  pre-existence  of  the  soul,  like  that  of 
the  animal,  and  the  subsistence  of  the  animal  like  that  of  the  soul.  In 
this  way  we  perceive  that  not  only  the  soul,  but  also  the  animal  must 
always  subsist  in  the  ordinary  course  of  things."-' 

The  reader  must  have  already  remarked  that  there  is  a  resemblance 
between  this  system  and  that  of  Pythagoras  on  the  transmigration  of 
souls.  In  vain  does  Leibnitz  deny  this  similitude  ;  the  subtile  distinc- 
tions by  means  of  which  he  strives  to  show  the  difference,  prove,  them- 
selves, that  there  exists  analogy  between  them,  if  not  identity.  The 
system  of  Metempsychosis  is  too  little  known  to  us ;  it  has  been  too 
much  disfigured  by  successive  traditions  for  us  to  be  able  now  to  form  a 
decisive  judgment  on  the  exact  degree  of  its  homogenity  with  any 
modern  system.  But  if  this  homogenity  were  proven — far  from  consti- 
tuting an  unfavorable  precedent  for  the  system  of  monads — it  would, 
on  the  contrary,   sustain  that  doctrine,  by  showing  its  origin  in  the 

"  Considerations  on  the  Priaciple  of  Life. 


THEORIES   AND   SYSTEMS.  505 

remotest  periods.  The  strongest  objection  to  tlie  hypothesis  of  monads 
is,  that  it  is  not  founded  on  any  observations,  and  is  offensive  to  our 
common  sense. 

"  Leibnitz,"  says  the  historian  Tenneman,  *' was  led  to  his  philosophic 
system  by  a  profound  comparison  of  the  most  celebrated  systems,  placed 
in  relation  with  the  demands  of  his  epoch  by  an  imagination  fertile 
in  ingenious  hypotheses  and  full  of  sense,  as  well  as  in  means  of 
reformation  and  concilliation ;  finally,  by  his  great  learning  in  mathe- 
matics. His  aim  was  to  rebuild  philosophy,  so  that  it  might  boast  of 
a  precision  analogous  to  that  of  mathematics,  and  put  an  end  to  all  the 
disputes  of  the  various  schools,  as  well  as  to  those  of  theology,  by  occu- 
pying, itself,  this  ground.  He  dreamed  then,  principally,  to  perfect  his 
method,  and  to  establish  some  positive  principles,  in  the  hope  of  remov- 
ing the  causes  of  dissensions  among  the  opposing  sects.  In  short,  he 
thought  that  philosophy  should  be  treated  like  mathematics.  In  this 
respect  he  favored  the  demonstrative  method,  and  the  system  of  ration- 
alism, as  Plato  and  Descartes  had  believed  it  to  be. 

"  Leibnitz  has  nowhere  given  a  complete  exposition  of  all  parts  of 
his  system  ;  each  of  his  doctrines  remained  more  or  less  separated  from 
the  whole.  His  ideas  are,  for  the  most  part,  the  result  of  a  certain 
kind  of  analysis  and  combination,  or  of  a  learned  artifice  to  reconcile 
the  difference  between  theology  and  philosophy,  and  of  an  exclusive  and 
incomplete  examination  of  the  faculty  of  understanding.  Preoccupied 
with  the  idea  that  by  thought  we  may  arrive  at  the  knowledge  of  the 
reality  of  things,  he  addressed  himself  to  the  understanding  alone,  as 
Locke  had  addressed  himself  to  sensibility  alone — to  discover  the  abso- 
lute principle  of  life  and  knowledge.  Thereby,  he  confounds  the 
logical  possibility  and  reality  with  positive  reality ;  he  intellectualizes  the 
phenomena,  and  ignores  the  part  which  observation  plays  in  the  acqui- 
sition of  knowledge.  Nevertheless,  his  philosophy,  full  of  bold 
hypotheses  and  superior  views,  has  made  new  steps  in  science ;  it  has 
put  in  circulation  a  crowd  of  new  ideas,  with  so  much  more  success  as  it 
was  published  in  the  French  language."  '•■■ 

We  have  I  think,  sufl&ciently  established,  by  the  example  of  Descartes 
and  of  Leibnitz,  to  whom  we  may  join  that  of  Plato,  and  many  other 
authors  who  have  been  cited  in  the  course  of  this  history — we  have,  I 
say,  sufficiently  established  how  the  deductive  method  is  deceptive  in 
regard  to  physical  sciences,  and  how  it  tends  to  separate  us  from  the 
material  reality  of  the  observation  of  phenomena.     It  should  be  now 

^  Manuel  de  I'Histoire  de  Philosophie,  translated  from  the  German  by  Victor 
Cousin.    Paris,  1839. 
32 


506  REFORM   PERIOD. 

demonstrated  for  us,  that  this  method  is  not  anything  like  as  sure  as 
that  of  induction,  in  this  particular  order  of  knowledge. 

Kant,  rendered  circumspect  by  the  shipwreck  of  so  many  superior 
minds  turned  his  speculations  toward  another  object :  in  place  of  seeking 
the  origin  or  essence  of  things  in  themselves,  he  proposed  to  determine 
what  is  the  mode  of  comprehension  of  the  human  mind,  and  what  are 
its  natural  limits.  He  devoted  himself,  for  the  attainment  of  this  aim, 
to  the  most  patient  and  profound  examination  of  which  the  annals  of 
philosophy  have  any  example,  and  after  forty  years  of  meditations,  he 
published  the  result  he  had  reached,  which  is  summed  up  as  follows, 
relative  to  the  knowledge  that  we  are  able  to  acquire  of  sensible  things : 
Reason  was  only  given  to  us  to  form  experience  ;  and  our  mind,  in 
desiring  to  pass  the  limits  of  sensation,  in  phenomena  of  the  material 
order,  mistakes  its  rights,  as  tvell  as  its  poiversS' 

This  result  is  very  remarkable,  and  merits  our  fixed  attention,  for 
it  oflFers,  under  another  form,  the  confirmation  of  the  aphorisms  of  the 
Sensualist  philosophy,  which  we  have  heretofore  announced.  Thus, 
Kant,  starting  from  idealism,  that  is  to  say,  from  the  pole  opposite  to 
that  of  Locke,  arrives  at  the  same  conclusion  as  the  former,  relative  to 
the  knowledge  of  sensible  objects ;  he  stops  at  the  same  limit,  also — 
the  sensations — in  the  domain  of  the  physical  sciences.  This  was  a 
fact  important  to  establish,  and  which  should  give  us  an  entire  confi- 
dence in  the  aphorisms  heretofore  stated.f 


§  IV.     Conclusion. 

This  rapid  and  very  incomplete  sketch  of  the  history  of  philosophy, 
during  the  last  two  centuries,  shows  us  two  sects  of  philosophers,  seeking 
the  truth  by  two  difi"erent  ways.     The  one,  more  particularly  addicted 

'^  Critique  de  la  Raison  Pure. 

f  The  reform  introduced  by  Kant,  in  philosophy,  relates  principally  to  moral 
and  metaphysical  ideas,  for  which  the  doctrine  of  Locke  does  not  offer  a  solid 
basis.  Emanuel  Kant  was  born  in  Kiniigsberg,  in  1724,  and  died  while  pro- 
fessor in  the  same  city,  in  180i.  "  He  was,"  says  Tenneman,  "  a  second  Socrates, 
who,  by  a  new  method,  reanimated  the  mind  for  researches,  taught  it  to  know 
its  whereabouts,  and  led  reason  into  a  scientific  route,  by  teaching  it  to  know 
itself.  Possessed  of  rare  talents,  cultivated  and  developed  with  care,  he  rendered 
himself  worthy  of  such  a  vocation.  His  moral  and  religious  character  prevented 
him  from  following  pure  speculation,  and  made  him  the  impersonation  of  his 
doctrine.  A  constant  love  of  truth,  joined  to  the  purest  moral  disposition,  was 
the  soul  of  his  philosophic  genius,  which  united,  in  an  eminent  degree,  originality, 
strength,  depth,  and  sagacity."     (Man.  de  Vllist.  de  la  Philosophic,  T.  II,  p.  225. 


THEORIES   AND   SYSTEMS.  507 

to  the  study  of  the  physical  sciences,  connects  all  our  ideas  with  sensa- 
tions, assuming  to  deduce  from  that  source,  not  only  the  knowledge  of 
sensible  objects,  but  also  that  of  moral  and  religious  truths,  such  as 
the  existence  of  God,  the  free  will  of  man,  etc.  Their  favorite  mode 
of  reasoning  is  that  of  induction ;  but  they  also  make  use  of  syllo- 
gisms. They  have  been  called  sensualists,  because  they  regard  the  sensa- 
tions as  the  basis  of  all  our  acquirements  ;  empirics,  because  the  rules 
which  they  trace  have  for  their  object,  to  direct  experience,  and  take 
their  foundation  in  observation.  Their  method  is  the  most  favorable  for 
the  advancement  of  the  natural  sciences,  properly  said  ;  it  was  adopted 
by  the  greatest  philosophers  or  naturalists  of  antiquity  and  modern 
times,  such  as  Aristotle,  Galileo,  Newton,  Linnaeus,  and  Cuvier.  It 
should  be  preferred  in  medicine,  for  it  is  according  to  it  that  the  philo- 
sophic aphorisms,  or  axioms,  were  established,  which  guide  us  in  the 
appreciation  of  medical  doctrines. 

The  other  sect,  more  attentive  to  the  phenomena  of  pure  thought,  or 
consciousness,  endeavors  to  comprehend  the  material  world  by  the  same 
plan,  and  desires  to  explain  physical  phenomena  by  the  laws  of  the 
mind.  They  have  been  called  idealists,  because  they  pretend  to  deduce 
all  our  knowledge  from  ideas  ;  rationalists,  because  the  rules  which  they 
trace  have  for  their  object  the  direction  of  reasoning.  They  proceed, 
ordinarily,  by  the  deductive  or  syllogistic  method.  Now,  we  have  seen 
the  deceptive  nature  of  this  method  in  the  physical  sciences  ;  how  it 
tends  to  divert  our  attention  from  the  real  world,  and  carry  it  to  the 
fictitious  world.  Xevertheless,  the  metaphysician  of  Ktinigsberg  attained 
by  this  route  the  confirmation  of  the  aphorisms  which  the  sensualists 
had  formed  ;  which  proves  that  no  method  necessarily  leads  either  to 
error  or  truth,  in  any  department  of  knowledge.  The  deductive  method 
is  more  favorable  than  the  inductive  one,  for  the  discovery  and  demon- 
stration of  moral  and  metaphysical  truth  ;  it  has  generally  been  pre- 
ferred by  the  great  moralists  and  profound  thinkers  of  every  age,  such 
as  Plato,  Descartes,  Pascal,  Leibnitz,  Kant. 

Nearly  all  the  philosophers  of  both  sects,  charmed  by  the  infallibility 
of  mathematical  propositions,  strove  to  imitate  the  mathematical  mode 
of  reasoning,  hoping  to  reach  by  it  convincing  demonstrations,  and  be 
sheltered  from  all  controversy.  Vain  eiforts !  they  pursued  a  chimera 
which  it  is  permitted  to  no  man  to  attain ;  the  essence  of  things  cannot 
be  changed  by  formula  of  language  or  reasoning.  If  they  had  well 
reflected  on  the  nature  of  mathematical  propositions,  they  would  have 
perceived  that  their  character  of  certainty  does  not  depend  either  on  the 
signs  or  the  method  which  mathematicians  employ ;  but  upon  the  nature 
itself  of  the  propositions,  which  is  such  that  they  reach  our  understandings 


508  EEFORM   PERIOD. 

by  the  double  way  of  experiment  and  pure  reason,  wbich  leads  to  the 
conviction  of  our  minds  in  an  irresistible  manner,  without  leaving  any 
open  door  to  doubt  or  hesitation.  Let  a  geometrician,  for  example,  take 
the  hight  of  a  tower  by  a  trigonometrical  process,  and  afterward  mea- 
sure its  hight  with  a  line ;  he  will  find  by  these  two  processes  nearly 
identical  results,  which  will  confirm  in  his  mind  the  demonstrability  of 
the  theories  of  trigonometry.  For  ages  the  predictions  of  astronomers, 
on  the  appearance  and  duration  of  eclipses,  are  verified  with  a  punc- 
tuality which  must  inspire  us  with  full  confidence  in  the  exactness  of 
their  theories  and  calculations.  Experimental  proof,  it  may  be  said, 
adds  nothing  to  the  certainty  of  the  theoretic  demonstrations  of  geometry. 
That  is  true,  but  the  experimental  proof  adds  to  the  conviction  of  the 
mind ;  it  strikes  the  ignorant  like  the  learned — forbids  doubt  and  dissi- 
pates obscurity. 

It  is  not  the  same  with  the  other  sciences :  in  examining  them  care- 
fully, we  shall  see  that  none  of  them  shares  with  mathematics  -the  privi- 
lege of  seizing  upon  our  understanding  by  the  double  route  of  reason  and 
experiment.  Moral  and  metaphysical  truths,  for  example,  are  not  sus- 
ceptible of  any  experimental  demonstration ;  it  is  only  by  reason  that 
we  prove  the  existence  of  God,  his  infinite  attributes,  the  immortality  of 
the  soul,  the  blessedness  of  virtue,  etc.  Physical  truths,  on  the  contrary, 
cannot  be  demonstrated  in  any  other  way  than  by  experiment ;  thus,  the 
property  possessed  by  acids,  of  uniting  with  alkalies  to  form  salts,  has 
been  ascertained  and  can  only  be  proved  by  experiment.  Thus,  obser- 
vation  alone  has  shown,  and  proves  every  day,  that  the  abuse  of  alcoholic 
drinks  enfeebles  the  brain  ;  but  our  intelligence  cannot  define  any  neces- 
sary connection  between  these  causes  and  their  respective  efi"ects.  It  is 
the  same  for  all  the  phenomena  of  the  material  universe  which  are  not 
within  the  range  of  mathematics  ;  these  phenomena,  as  well  as  the  laws 
which  regulate  them,  can  only  be  demonstrated  by  experiment. 

I  could  have  wished  to  spare  my  readers  this  digression  into  the  field 
of  philosophy  ;  but  it  has  appeared  to  me  indispensable,  and  I  hope  will 
not  prove  unfruitful.  It  has  furnished  us,  in  the  first  place,  with  an 
occasion  to  make  choice  of  a  method  with  discernment ;  then  it  has 
shown  us  the  limits  where  must  be  arrested  our  faculty  of  acquiring 
knowledge  of  sensible  things ;  finally,  we  have  established  some  aphorisms, 
which,  like  guide-posts  planted  on  the  route  which  we  are  to  follow,  will 
direct  us  in  the  examination  of  medical  doctrines,  and  abridge  considerably 
our  labor. 


THEORIES  AND   SYSTEMS.  509 

ART.  IL    SOURCES  OF  ANIMISM  AND  CHYMIATRIA.e 

Among  the  men  who  contributed  the  most  to  discredit  the  ancient 
doctrines,  and  to  introduce  the  taste  for  novelties  in  Medicine,  we  shall 
cite,  in  the  first  phice,  John  Baptist  Van  Helmont,  Lord  of  Merode  and 
of  several  other  estates.  He  distinguished  himself  early  by  his  applica- 
tion to  study,  his  piety,  and  the  independence  of  his  opinions.  At  the 
age  of  seventeen  years  he  was  offered  the  degree  of  master  in  philosophy, 
but  he  refused  it ;  knowing,  he  said,  that  his  head  was  furnished  with 
words  only,  and  he  was  not  willing  to  be  dubbed  master  in  the  sciences, 
when  he  was  scarcely  a  scholar.  Having  renounced  the  academic  dig- 
nities, and  the  schools  where  futile  matters  only  were  taught,  to  devote 
himself,  in  all  the  independence  of  his  genius,  to  researches  after  truth, 
he  read  at  first  the  writings  of  the  pagan  philosophers,  and  acquired 
some  taste  for  the  doctrines  of  the  stoics ;  but  afterwards  the  books  of 
Thomas  a  Kempis  and  of  John  I'aulerus  falling  into  his  hands,  decided 
his  inclination  toward  mysticism.  "  I  saw,"  he  said,  "  that  all  truth 
and  wisdom  comes  from  God,  to  whom  man  unites  himself  by  prayer, 
contemplation,  and  good  works."  Henceforth  he  studied  to  regulate  his 
conduct  by  the  example  of  Jesus  Christ ;  and  in  order  to  copy  closer  this 
divine  model  in  the  relief  of  human  misery,  he  resolved  to  study 
Medicine. 

He  embraced  this  study  with  the  ardor  of  an  enthusiast  and  the 
obstinacy  of  a  fanatic ;  he  consecrated  to  it  thirty  consecutive  years, 
and  after  having  read,  annotated  and  extracted  from  more  than  six 
hundred  Arab  and  Latin  authors,  he  found  himself  in  a  condition  to 
dispute  on  all  diseases,  in  a  way  to  excite  the  admiration  of  the  most 
skillful.  He  took,  then,  the  title  of  Doctor.  Afterward,  he  passed 
through  Italy,  France,  England  and  Spain,  in  short,  Europe  entire,  in 
order  to  initiate  himself  directly  in  the  process  of  the  Healing  Art  in 
use  in  each  country,  and  to  collect  all  the  secrets  of  alchymy.  On  his 
return  to  Brussels,  the  capital  of  his  country,  he  divided  his  time  there- 
after between  the  practice  of  medicine  and  labors  in  his  laboratory,  in 
which  he  sometimes  shut  himself  up  for  entire  days.  His  discoveries 
in  chemistry  have  secured  him  a  distinguished  place  in  the  history  of 
that  science ;  but  we  can  only  occupy  ourselves  at  present  with  his 
opinions  in  medicine. 

Van  Helmont  proscribed  blood-letting  as  injurious  in  all  cases  ;  and, 
without  rejecting  purgatives  in  an  absolute  manner,  he  made  a  very 
moderate  use  of  them.     His  favorite  remedies  were  opium,  wine,  and 

■^Doctrines  -which  assumed,  respectively,  for  all  the  healthy  and  morbid  phe- 
nomena of  the  economy,  the  influences  of  a  presiding  soul  and  the  laws  of  chemistry. 


510  REFORM    PERIOD. 

compositions  which  he  prepared  himself,  into  which,  like  Paracelsus 
and  other  chemical  physicians,  he  incorporated  substances  taken  from 
the  mineral  kingdom. ■•=  He  cured,  with  these  preparations,  certain 
diseases  which  had  resisted  ordinary  means ;  but  how  many  individuals 
found  themselves  made  worse  by  the  improper  use  of  remedies  yet  too 
little  proven  ! 

His  writings  abound  in  new  words  and  odd  ideas,  which  render  their 
reading  fatiguing.  We  meet  there,  entire  chapters  of  impenetrable 
obscurity,  so  that  they  form  the  natural  transition  from  the  ramblings 
of  Paracelsus  to  the  learned  theories  which  we  shall  soon  have  to 
examine.  Nevertheless,  no  one  could  place  Van  Helmont  in  parallel  with 
the  Swiss  thaumaturg,  to  whom  he  was  superior  in  all  respects,  and  for 
whom  he  professed  a  profound  contempt.  Eich  in  an  uncommon  erudi- 
tion, and  his  own  proper  experience,  the  Belgian  physician  knew  how  to 
avail  himself  of  these  to  sap  the  prejudices  of  the  schools  ;  and  he  is 
never  so  clear  and  so  precise  as  when  he  wishes  to  uncover  the  naked- 
ness of  the  hollow  verbiage  of  the  physics  of  Aristotle,  and  the  physi- 
ology of  Galen.  He  asks,  for  example,  on  what  foundation  the  schools 
sustain,  with  their  Aristotle,  that  the  air  is  humid  at  eight  degrees, 
and  hot  at  four  degrees  ?  By  what  experiment  they  prove  that  condensed 
air  is  turned  into  water,  and  becomes  thus  a  perpetual  food  for  the 
springs  ?  At  the  same  time  he  cites,  in  support  of  a  contrary  opinion, 
the  experiment  by  which  air  is  compressed  in  a  gun-barrel  without 
exhibiting  the  least  particle  of  water,  whatever  the  degree  of  condensation 
to  which  it  may  haA^e  been  submitted. 

But  when  he  abandons  the  role  of  the  critic,  and  attempts  to  found, 
in  his  turn,  a  system  of  natural  philosophy,  he  falls  into  such  a  confu- 
sion of  ideas  that  it  would  be  impossible  to  analyse  his  doctrine.  All 
that  we  are  able  to  do,  is  to  report  here  some  of  the  propositions  which 
appear  to  form  its  basis.  Van  Helmont  admits  two  material  principles 
for  all  things ;  the  one  is  water,  which  furnishes  matter,  the  other  is 
the  ferment  or  seminal  breath  which  gives  it  form.  At  other  times 
he  says,  that  the  two  principles  of  all  created  beings  are  air  and  water, 
because  they  cannot  be  transmuted  into  each  other.  In  regard  to  the 
earth,  he  believed  that  it  proceeded  from  water,  by  a  secondary  forma- 
tion. The  archens  is  a  spiritual  gas,  which  gives  impulsion  to  the 
fecundated  seed,  by  means  of  a  ferment.  It  regulates,  like  a  skillful 
architect,  all  the  movements  with  which  the  natural  body  is  endowed ; 
and  it  remains  in  them  until  their  dissolution.  Without  it  no  organized 
being  could  acquire  the  form  that  is  proper  to  it — everything  would  be 

*  See  letter  of  Guy  Patin.    Paris,  1846. 


THEORIES   AND   SYSTEMS.  611 

confounded,  and  tlie  universe  would  re-enter  into  chaos.  Besides  the 
archeus  and  the  ferments,  Van  Helmont  sometimes  endows  the  animal 
economy  with  a  third  motor,  which  he  names  hlas.  The  nature  of  this 
is  double ;  one  part  produces  the  natural,  and  the  other  the  voluntary 
movements.  The  stars,  also,  have  a  double  hlas  ;  the  first  moves  them 
in  space ;  the  second  excites  the  special  revolutions  to  which  their  sub- 
stance is  subject.  The  bias  of  the  stars  and  of  man  agree  with  each 
other ;  so  that  we  may  predict  certain  atmospheric  vicissitudes  by  the 
aspect  of  the  infirmities  which  aiflict  the  human  body,  and  better  still  by 
those  which  are  seen  in  brutes,  because  the  animals  were  created  before 
man. 

If  from  these  general  notions  we  descend,  with  this  author,  to 
the  particular  functions  of  each  part  of  the  body,  we  shall  find  that  he 
accords  to  the  stomach  and  the  spleen  a  sort  of  omnipotence  over  the 
rest  of  the  body,  which  he  characterizes  by  the  picturesque  expression 
of  duumvirate.  The  archeus  or  conscious  soul  resides  on  one  or  other 
of  these  two  viscera,  and  more  especially  on  the  pylorus.  From  this 
position  it  directs  all  the  functions  of  the  other  organs,  watching  the 
integrity  of  each,  and  maintaining  the  harmony  of  the  whole. 

There  are  six  digestions :  the  first  takes  place  in  the  stomach,  by  the 
aid  of  an  acid  ferment  which  the  spleen  supplies ;  the  second,  in  the 
duodenum,  where  the  bile,  mingling  with  the  alimentary  bolus,  changes 
its  acidity  into  a  volatile  salt ;  the  third,  in  the  mesenteric  veins,  where 
the  chyle  is  transformed  into  venous  blood,  otherwise  called  cruor ;  the 
fourth  digestion  is  eficcted  in  the  heart,  by  means  of  heat,  agitation, 
and  a  particular  ferment,  which  causes  the  venous  blood  to  become  arte- 
rial ;  the  fifth  digestion  takes  place  in  the  brain,  where  the  vital  spirit 
is  extracted  from  the  arterial  blood ;  the  sixth  consists  in  the  work  of 
assimilation,  which  each  part  executes  in  appropriating  by  virtue  of  its 
innate  spirit,  the  aliment  that  is  natural  to  it.  With  the  number 
seven,  nature  keeps  a  sabbath,  in  other  words,  rests. 

Let  us  now  take  a  glance  at  the  pathology  of  this  author.  AVheu 
the  archeus  is  oiFended  by  any  injurious  or  disagreeable  agent,  it  becomes 
furious,  or  it  is  seized  with  fear,  which  produces  disordered  movements, 
and  the  image  which  this  trouble  depicts  in  it  becomes  the  seminal 
idea  of  the  disease.  There  are  as  many  species  of  diseases  as  there  are 
morbid  seminal  ideas  of  different  characters,  and  the  primitive  seat  of 
all  our  affections  is  in  the  tunic  of  the  stomach,  which  is  the  habitual 
residence  of  the  archeus.  Morbific  causes  were  of  two  sorts,  those 
from  without,  as  miasms,  epidemics,  poisons,  virus,  unsound  food  and 
drinks,  etc.  ;  the  others  are  from  within,  and  consist  in  some  excre- 
mentitial  matter  not  evacuated  at  the  proper  time» 


512  REFORM   PERIOD. 

Fever  is  the  result  of  extraordiaary  efforts  made  by  the  archeus  to 
disembarrass  itself  of  the  morbid  idea  which  troubles  it ;  from  this 
struggle  proceed  those  intervals  of  excitement  and  agitation  that  suc- 
ceed each  other.  The  chill  indicates  the  state  of  terror  or  exhaustion 
of  the  archeus ;  the  heat  announces  the  violence  of  the  efforts  and 
struggle  which  it  undertakes.  Vesicular  calculi  are  formed  by  the  acci- 
dental combination  of  three  sorts  of  spirits  which  exist  in  the  urine,  in 
the  ordinary  state  of  isolation.  The  first  is  a  salino- volatile  spirit ;  the 
second  is  of  a  vinous  and  inflammable  character  ;  the  third  of  an  earthy 
nature.  The  tophaceous  concretions  in  gouty  persons  are  engendered 
by  the  synovia,  a  species  of  transparent  liquor,  destined  to  lubricate  the 
joints,  which,  in  becoming  acid,  looses  its  aqueous  part,  and  becomes 
dry  and  hard. 

In  regard  to  therapeutics,  Van  Helmont  laid  down  the  principle  that 
the  first  condition  for  the  favorable  operation  of  a  medicine  was,  that  it 
comport  with  and  be  agreable  to  the  archeus ;  then,  that  it  be  adminis- 
tered in  proper  doses  and  at  proper  times.  He  thought  that  the  actual 
virtue  of  remedies  resides  especially  in  their  odors ;  these  being,  he 
said,  the  symbol  of  the  seminal  ferment,  and  the  cause  of  all  the  trans- 
mutations that  are  effected  in  the  human  body.  Besides,  he  had  faith 
in  the  efficacy  of  certain  words,  as  well  as  in  amulets  and  talismans. 
He  believed  in  the  efficacy  of  a  universal  remedy,  which  he  named 
alkacst,  ens  primum,  primus  viefcdlus,  etc. 

Van  Helmont  had  no  disciples,  properly  said ;  he  founded  no  sect, 
but  several  modern  medical  sects  have  borrowed  their  ideas  from  him. 
The  chemical  school  owes  to  him  the  idea  of  ferments ;  the  animists  or 
vitalist  school,  that  of  the  sensitive  soul  or  vital  principle,  formed  on 
the  model  of  the  archeus.  The  thaumaturgs,  the  Eosicrucians,  and  the 
magnetisers  regard  him  as  one  of  their  adepts,  or  pretend,  at  least,  to 
find  in  his  writings  some  traces  of  their  doctrines.  The  partisans  of 
scholastic  traditions  never  had  a  ruder  adversary.  "  At  an  epoch  when 
there  were  still  found  on  all  sides  those  who  held  to  the  doctrines  of  the 
middle  ages,  when  the  forces  of  nature,  interrogated  with  fear,  seemed 
always  to  present  themselves  under  a  mysterious  and  supernatural  form, 
it  is  not  astonishing  that  the  mystical  spirit  of  Van  Helmont  saw  in 
the  ecstacies  of  his  soul,  and  in  his  dreams,  the  revelation  of  the  solu- 
tion of  the  most  embarrassing  problems.  Xor  is  it  any  more  astonish- 
ing, that  he  substituted  hypotheses  for  hypotheses,  and  errors  for  errors. 
The  men  of  those  times  were,  in  regard  to  a  thousand  questions  now 
clear  to  us,  in  the  same  condition  as  we  are  at  present,  in  regard  to  the 
difficulties  insoluble  by  our  means  of  investigation.  What  theory  is 
sufficient  for  the  cure  of  intermittents  by  Peruvian  bark,  the  origin  of 


( 


THEORIES  AND    SYSTEMS.  513 

variola,  and  the  destruction  of  its  germ  by  vaccine  ?  Who  has  not 
made  a  desperate  eiFort  to  pierce  this  obscurity,  to  get  a  glance  beyond 
this  horizon  ?  Very  well,  let  us  turn  the  eye  upon  this  past,  which 
was  their  future,  or  our  light,  which  was  darkness  to  them,  and  repre- 
sent to  ourselves  the  false  lights,  and  the  gropings  of  our  predecessors — 
so  much  easier  to  go  astray,  as  they  had  not,  like  us,  a  guiding  compass, 
in  the  method  of  observation,  and  as  they  could  scarcely  abstain  from 
hypotheses  in  the  absence  of  facts."  " 


ART.  III.    lATRO-CHYMIA. 

Francis  de  Lebo,  called  Sylvius,  was  the  first  who  pretended  to 
explain  all  the  phenomena  of  the  living  economy  by  the  laws  of  chem- 
istry alone.  He  was  in  his  forty-fourth  year,  and  enjoyed  the  reputation 
of  being  the  most  skillful  physician  in  Amsterdam,  when  he  was  called 
to  teach  practical  medicine  in  the  University  of  Leyden.  Before  his 
time,  tlie  professors  contented  themselves  by  reading  from  the  chair,  and 
commenting  upon,  before  their  pupils,  the  most  renowned  authors. 
Lebo  had  the  happy  thought  of  admitting  his  young  auditors  to  visit 
the  sick  in  the  city  hospital,  and  to  choose  for  the  subject  of  his  lectures 
the  diseases  they  had  before  them.  He  was  thus  one  of  the  originators 
of  clinical  teaching,  and  it  is  to  this  day  his  best  claim  to  distinction. 
He  cultivated,  with  signal  success,  anatomy  and  chemistry,  and  at  the 
epoch  when  the  discovery  of  the  circulation  of  the  blood  excited  the 
whole  medical  world,  he  was  one  of  the  first  to  declare  himself  in  favor 
of  the  doctrine  of  W.  Harvey,  and  sustained  it  by  new  proofs,  drawn 
from  the  examination  of  dead  bodies.  In  short,  he  was  accustomed  to 
recommend  anatomy,  chemistry,  and  clinical  observation,  as  the  true 
basis  of  medical  instruction.  This  celebrated  iatro-chemist  died  in 
1672,  aged  fifty-eight  years. 

Sylvius  declared,  in  substance,  that  nothing  must  be  held  as  true,  in 
medicine,  which  had  not  been  confirmed  by  the  testimony  of  the  senses — 
an  opinion  conformable  to  ouvjifth  philosophic  aphorism.  We  will  now 
proceed  to  see,  if  in  the  development  of  his  physico-pathological  theory, 
he  is  always  true  to  this  wise  maxim. 

PHYSIOLOGY. 

He  describes  the  act  of  digestion  as  follows  :  The  food,  he  says,  is  at 
first  triturated  in  the  mouth,  where  it  is  impregnated  with  saliva,  a 
liquid  endowed  with  great  fermenting  properties.     Thence  it  descends 

^  M.  Littre,  .Journal  Hebdomadaire  de  Medccine,  Paris,  1830,  T.  "VI.,  p.  413. 


§14  REFORM   PERIOD. 

into  the  stomacli,  and  there  encounters  the  residuum  of  the  preceding 
digestion,  a  species  of  leaven  very  favorable  to  stomachal  digestion,  by 
means  of  which  it  undergoes  a  second  preparation  ;  after  which  it  passes 
into  the  intestine,  in  the  form  of  a  viscid  and  whitish  humor.  A  little 
below  the  pylorus  this  alimentary  humor  undergoes  a  third  fermentation, 
by  the  united  action  of  the  bile,  pancreatic  juice,  and  the  saliva.  Then 
the  purest  and  most  fluid  part  separates  from  the  thickest  and  crudest 
part.  The  latter,  carried  on  to  the  large  intestine,  takes  the  form  and 
name  of  feces,  while  the  other,  deprived  of  its  excrementitious  matter, 
is  termed  chyle,  and  goes  through  the  lacteal  veins  to  the  thoracic  canal, 
where  it  unites  with  the  lymph.  The  humor  resulting  from  this  union 
is  carried  to  the  vena  cava  superior,  where  it  is  mingled  with  the  blood, 
and  communicates  to  that  fluid  its  nutritive  quality.  The  venous  blood, 
thus  restored,  reaches  the  right  cavities  of  the  heart,  and  thence  goes  to 
the  left  cavities,  by  traversing  the  lungs.  In  its  passage  through  the 
lungs,  the  blood  undergoes  a  last  efi'ervescence,  which  brings  it  to  its 
highest  degree  of  perfection.- 

This  description  of  the  function  of  digestion  is  distinguished  from 
that  of  Van  Helmont  by  much  greater  anatomical  exactness,  and  by 
no  intervention  of  the  archeus.  The  saliva,  bile,  and  pancreatic  juice, 
have  in  this  the  active  agency — an  agency  that  Sylvius  denominates 
trmmvirale.  The  bile,  he  says,  which  holds  the  first  rank,  owes  its 
virtue  to  an  alkaline  salt,  tempered  by  an  oily,  volatile  spirit.  The 
saliva  obtains  its  virtue  from  the  acid  and  volatile  spirit  that  enters  with 
water  into  its  composition.  The  pancreatic  juice  owes  its  activity  to  an 
acescent  volatile  spirit. 

The  animal  spirits  are  extracted  from  the  blood,  which  reaches  the 
cerebrum  and  cerebellum  by  the  carotid  arteries.  This  liquid  in  pene- 
trating into  the  capillary  vessels  loses  its  watery  part,  which  is  filtered 
through  the  pores,  and  acquires  a  character  that  very  much  resembles 
the  spirit  of  wine. 

Thirst  arises  from  the  saline  exhalations  that  rise  from  the  small 
intestines,  through  the  stomach  to  the  throat,  where  they  excite  a  sen- 
sation of  dryness.  These  exhalations  are  the  product  of  efi'ervescence 
of  acid  bile  mingled  with  the  pancreatic  juice.  Natural  hunger  arises 
at  first  from  the  fermentation  engendered  in  the  stomach  by  a  mixture 
of  the  residue  of  alimentary  residuum  with  the  saliva  that  we  continu- 
ally swallow.  This  fermentation  developes  a  halitus  of  an  agreeable 
acidity,  which  titillates  softly  the  superior  orifice  of  the  stomach,  and 
creates  the  desire  for  food.f 

^  Sylvii  Praxeos  Medicos  Idea  Nova,  cap.  x.,  §§  2,  3,  4.  f  Ibid. 


THEORIES  AND   SYSTEMS.  515 


PATHOLOGY. 

The  immediate  cause  of  continued  fevers  is  referred  to  a  vice  in  the 
bile  or  lymph  ;  a  vice  which  is  calculated  to  excite  in  the  right  ventricle 
of  the  heart  an  increase  of  eflFervescence,  from  which  results  the  con- 
tinual vehemence  of  the  pulse. 

The  cause  of  intermittent  fevers  consists  in  the  excessive  acrimony  of 
the  pancreatic  juice.  By  its  mixture  with  the  bile  and  pituite,  this 
vitiated  juice  provokes  an  abnormal  fermentation,  which  occasions  a 
chill,  more  or  less  marked,  until  the  bile,  flowing  in  its  turn  in  abund- 
ance, causes  an  increase  of  caloric  in  the  right  cavities  of  the 
the  heart,  and  creates  a  heat  to  succeed  the  chill.  However,  in  what- 
ever way  the  thing  takes  place,  it  appears  beyond  all  doubt,  that  the 
algid  period  in  all  fevers  arises  from  acidity  of  the  pancreatic  juice  or 
lymph,  while  the  hot  period  is  the  eiFect  of  the  bile,  whose  alkaline 
salt  united  to  oil  conserves  and  developes  eminently  the  element  of  fire. 

THERAPEUTICS. 

It  is  on  the  hypothesis  that  we  have  just  read,  and  other  similar  ones, 
that  Sylvius  founded  his  curative  indications  ;  he  opposed  purgatives  to 
diseases  proceeding  from  the  effervescence  of  the  bile  ;  he  pretended  to 
correct  the  acridity  of  that  humor  by  opium  and  other  narcotics  ;  he  was 
prodigal  in  volatile  salts  and  diaphoretics,  sometimes  with  the  purpose  of 
combatting  the  acidity  of  the  lymph,  or  the  pancreatic  juice  ;  again, 
in  order  to  arouse  the  sluggishness  of  the  vital  spirits,  and  favor  the 
secretions.  In  a  word,  he  created  an  incendiary  medicine,  based  on  a 
fictitious  theory,  which  he  believed  in  good  faith  to  be  the  only  pure 
expression  of  the  truth. 

But  if  we  judge  this  theory  by  the  light  of  the  philosophic  principle 
which  he  himself  has  laid  down  in  the  beginning,  and  which  consists, 
as  must  be  recollected,  in  holding  in  Medicine  as  true  only  what  is 
attested  by  the  testimony  of  the  senses,  we  shall  find  that  it  is  very  far 
from  fulfilling  such  a  condition.  In  fact,  of  the  three  humors  that  con- 
stitute his  physiological  triumvirate,  one  only,  the  bile,  possesses  in  a 
very  feeble  degree  the  alkaline  quality  that  he  attributes  to  it ;  the  other 
two,  namely,  the  saliva  and  the  pancreatic  juice,  do  not  at  all  appear 
endowed  with  the  acidity  that  he  attributes  to  them,  and  by  which  he 
assumes  their  co-operation  in  the  digestive  act,  as  well  as  in  the  gen- 
eration of  diseases.  It  might  also  be  asked,  on  what  direct  observation 
he  bases  himself,  to  aflBrm  that  the  animal  spirits  are  distilled  in  the 
capillary  tubes  of  the  encephalon,  like  the  spirits  of  wine ;  or,  for 
teaching  that  the  acidity  of  the  lymph,  or  the  pancreatic  juice  produces 


516  REFORM    PERIOD. 

the  fever  chill,  and  that  the  return  of  the  heat,  or  reaction,  is  due  to 
the  acridity  of  the  bile.  Finally,  his  whole  system  is  radically  wrong, 
on  account  of  its  insufficiency  and  errors ;  and  no  account  is  taken  in  it 
of  the  state  of  the  solids,  or  their  action. 

We  must  believe,  for  the  honor  of  a  practitioner  so  renowned  as  Syl- 
vius, that  he  departed  somewhat  from  his  theoretic  prejudices  at  the 
bedside  of  his  patients,  and  that  he  remembered  there  that  sentence 
which  he  had  himself  emitted:  How  many  of  the  specious  and  rea- 
sonable things,  in  theory,  are  known  to  be  vain  and  faulty  in  practice ! 

His  doctrine  made  rapid  progress  in  Germany  and  in  England,  but  it 
obtained  less  favor  in  France  and  Italy,  where  the  partisans  of  the 
ancient  Dogmatism  opposed  it  with  a  lively  resistance.  The  novelty  of 
the  phenomena  on  which  he  rested,  the  small  number  and  clearness  of  his 
principles — the  facility  of  their  application  in  the  treatment  of  diseases, 
were  all  well  calculated  to  seduce  enthusiastic  minds,  anxious  for  a 
change.  Besides,  as  we  have  already  remarked,  the  circumstances  were 
favorable  for  all  attempts  at  innovation  in  Medicine ;  for  the  antique 
edifice  of  the  Healing  Art  was  yielding  to  the  attacks  on  all  sides. 

Thomas  Willis,  cotemporary  of  Lebo,  and  a  still  more  celebrated  anato- 
mist than  he,  contributed  more  than  any  other  to  the  propagation  of  the 
taste  for  chemical  explanations  among  physicians.  After  having  taught 
natural  philosophy  for  six  years,  and  practiced  medicine  with  distinction 
at  Oxford,  he  resigned  his  chair  to  go  and  exhibit  himself  on  a  much 
greater  theater.  He  moved  to  London,  and  became,  in  a  short  time,  one 
of  the  most  distinguished  practitioners.  Being  adjunct  to  the  College  of 
Physicians  of  that  capital,  he  gained  the  friendship  of  his  colleagues, 
by  the  integrity  and  gentleness  of  his  character,  as  he  merited  their 
esteem  by  the  extent  and  variety  of  his  learning. 

The  system  of  this  iatro-chimicus  differs  notably  from  that  of  Lebo, 
though  established  on  the  same  order  of  considerations.  Willis  laid 
down  the  principle,  that  if  any  substance  whatever  is  submitted  to  the 
analysis  of  fire,  it  is  resolved  into  spirituous,  sulphurous,  saline,  aqueous 
and  terrestrial  particles :  from  which  he  concluded  that  there  are  five 
elements,  namely:  spirits,  sulphur,  salts,  water  and  earth.  He  excluded 
air  and  fire  from  the  number  of  elementary  bodies,  because  they  are 
neither  visible  nor  palpable.  "For,"  he  adds  ironically,  "my  intelli- 
gence is  obtuse,  and  my  reason  cannot  penetrate  beyond  the  reach  of  my 
senses."  We  perceive  that  most  of  -the  physicians  of  this  period 
accepted,  at  least  in  principle,  the  aphorisms  of  the  Sensual  Philosophy ; 
but  they  were  not  in  the  habit  of  submitting  to  them  their  medical 
theories;  thus  the  " spirits  "  which  Willis  placed  at  the  head  of  the 
elements,  do  not  appear  to  me  in  any  manner  more  visible  or  palpable 


THEORIES   AND    SYSTEMS.  517 

than  air  or  fire.  Could  anyone  so  soon  forget  the  philosophic  maxim  that 
he  seemed  to  take  for  a  motto  ?     This  is  what;  we  now  proceed  to  see. 

The  "  spirits,"  according  to  him,  are  an  ethereal  substance,  extremely 
subtile,  an  emanation  of  the  Divine  breath,  which  a  benificent  providence 
had  placed  in  the  sublunary  world,  to  impress  all  things  with  vital 
action.  Sulphur  is  au  element  of  a  little  more  consistency ;  it  evapo- 
rates less  promptly  than  spirits  ;  the  heat,  shape  and  beauty  of  bodies, 
as  well  as  their  colors,  aroma  and  taste,  depend  upon  the  proportion^of 
this  element.  Salt  has  still  more  density  ;  it  gives  to  substauces  weight 
and  solidity,  and  is  the  element  of  their  duration  and  reproduction. 
"Water  is  the  vehicle  of  spirits  and  sulphur,  and  favors  their  admixture 
with  salt ;  deprived  of  this  dissolvent,  the  other  elements  could  form  no 
union.  Earth  fills  the  pores  of  all  solid  bodies  ;  it  hinders  a  too  inti- 
mate contact  of  the  active  elements,  and  prevents  them  from  bruising 
each  other — retains  by  its  viscidity  those  which  are  too  volatile,  in  fine, 
gives  to  bodies  their  mass  and  volume.'---'^ 

Most  decidedly,  the  qualities  and  functions  which  Willis  ascribes  to  his 
elements  are  not  more  real  than  the  ancients  ascribed  to  theirs.  There 
is  no  more  reason  to  believe  that  heat,  beauty,  form,  colors,  aroma  and 
taste  come  from  sulphur,  than  to  admit  that  air  is  humid  at  eight 
degrees,  and  cold  at  four  degrees.  All  is  equally  fictitious  and  imag- 
inary ;  but  in  this  respect,  Willis  appears  to  me  more  faulty  than  the 
ancients,  for  he  puts  himself  in  manifest  contradiction  with  his  philo- 
sophic principles. 

Let  us  follow  now  the  application  of  his  theory  to  the  phenomena  of 
organized  bodies,  and  in  particular  to  the  animal  economy,  as  fermen- 
tation enjoys  here  a  great  role ;  let  us  in  advance  see  what  he  means  by 
the  term:  "Fermentation,"  says  our  chemist,  "is  an  internal  movement 
of  the  particular  elements  of  any  body  whatever,  having  for  its  object 
the  improvement  of  the  body  or  its  transformation  to  another  sub- 
stance. It  occurs  in  the  three  kingdoms — among  minerals  buried 
in  the  bosom  of  the  earth,  as  among  vegetables  and  minerals.  It  is 
sometimes  the  effect  of  art,  as  well  as  a  natural  result." 

PHYSIOLOGY. 

The  mind  perceives  the  first  development  of  life  in  the  heart ;  that 
viscus,  whose  rapid  movements  are  seen  by  the  eye,  offers  the  represen- 
tation of  a  fermenting  point — ■punctulum  ferinenteseens.  The  spirit 
bounds  from  this  rebounding  point  (punctum  saliens)  as  from  a  prison  ; 
but  the  sanguineous  liquid,  which  serves  it  as  a  vehicle,  prevents  it 

•^  De  Fermentatione  Sive  de  Motu  Corporum  Tnorganico,  cap.  n. 


518  REFORM    PERIOD. 

from  flying  off,  and  constrains  it  to  keep  on  the  track  ;  so  that  the  spirit 
going  and  coming,  unceasingly,  from  the  center  to  the  circumference, 
cuts  out  and  fashions  the  arteries  and  veins  that  subserve  the  circulation 
of  the  blood  in  all  parts  of  the  body. 

The  chyle  is  extracted  from  the  food  by  coction,  -which  is  eiFected  in 
the  stomach  by  the  aid  of  an  acid  ferment.  "  Some  pretend,"  continues 
Willis,  "that  this  ferment  comes  from  the  spleen ;  but  anatomy  has 
not,  up  to  this  time,  discovered  any  direct  communication  between  that 
viscus  and  the  stomach.  However  this  may  be,  the  chyle  acquires  a 
milky  color  by  the  coction  of  the  sulphurous  and  saline  parts,  mingled 
with  the  ferment  of  which  I  have  just  spoken." 

It  was  also  by  the  intermediation  of  a  ferment  that  the  animal 
spirits  were  separated  from  the  purest  sulphurous  portion  of  the  blood, 
in  the  cortical  substance  of  the  brain  and  the  cerebellum.  But  though 
the  process  by  means  of  which  this  operation  was  effected  was  a  little 
obscure  it  appeared  nevertheless  demonstrated,  that  in  this  circum- 
stance, the  cncephalon,  covered  by  its  bony  case,  and  furnished  with  its 
nervous  appendages,  fulfilled  an  office  similar  to  that  of  the  upper  part 
of  an  alembic  of  glass,  enclosing  a  sponge,  for  the  rectification  of  the 
spirit  of  wine. 

In  short,  each  apparatus  of  the  organic  body  possessed  a  particular 
ferment,  indispensable  to  the  exercise  of  its  functions,  so  that  it  might 
be  said  that  our  life  commenced  and  was  sustained  by  ferments.'-' 

PATHOLOGY. 

If  ferments  are  the  source  and  sustenance  of  life,  they  are  equally 
the  cause  of  our  death,  for  they  harbor,  after  Willis,  the  germs  of  all 
diseases.  Sometimes,  he  says,  the  sulphurous  and  spirituous  parts  of 
the  blood  are  exhaled  in  excess,  producing  an  ebullition  in  the  vessels 
like  the  fermentation  of  wine,  and  giving  rise  to  febrile  afiiections  of  all 
species ;  again,  the  saline  part  effervesces,  communicating  to  the  blood 
an  acid,  austere,  or  bitter  quality,  which  causes  it  to  coagulate  in  vari- 
ous ways;  from  this  proceed  most  of  the  chronic  diseases,  such  as 
scorbutis,  dropsies,  lepra,  etc. 

All  the  intermittents  were  due  to  a  superabundance  of  the  non- 
assimilated  digestive  juice,  which,  in  circulating  with  the  blood,  excites 
an  ebullition  which  continues  until  all  the  morbific  matter  has  been 
expelled ;  then  only  is  a  calm  re-established — an  intermission  more 
or  less  long  succeeds  the  febrile  agitation. 

Continued    fevers   are   engendered   in   the   following   manner ;    the 

^  De  Fermentatione  Sive  de  Motu.  Oorporum  Inorganico  chap.  v. 


THEORIES  AND   SYSTEMS.  519 

spirituous  portion  of  the  blood  being  agitated  or  heated,  produces  an 
ephemeral  fever,  or  a  legitimate  synocha.  If  the  fermentation  extends 
to  the  sulphurous  particles,  a  putrid  fever  results.  In  fine,  ■when  a 
poisonous  miasm  enters  into  the  circulating  fluid,  it  provokes  not  only 
the  efi"ervescence  of  the  spirituous  and  sulphurous  molecules,  hut  also 
separates  the  elements  of  the  blood,  giving  rise  to  putridities  and 
strange  coagulations,  and  those  alarming  and  extraordinary  symptoms 
supervene  that  mark  extreme  peril,  and  which  characterize  malignant 
fevers — the  plague,  small  pox,  etc. 

Phrensy  consists  in  the  irritation  by  the  spirits  of  the  brain,  which, 
abandoning  themselves  to  confused  and  disordered  movements,  derange 
all  the  functions  of  the  soul.  But  when  the  spirits  realize  another 
order  of  alteration,  when,  for  example,  their  substance  changes  its 
nature  and  becomes  ascesent,  sour,  or  insipid,  instead  of  its  former 
salino-spirituous  condition,  then,  I  say,  they  engender  other  sorts  of 
madness,  such  as  melancholy,  dementia,  idiocy,  etc. 

THERAPEUTICS. 

It  was  also  by  the  aid  of  ferments  that  all  diseases  were  cured,  and 
the  office  of  the  physician,  says  AYillis,  resembles  very  much  that  of  the 
butler,  who  watches  that  the  fermentation  of  the  wine  takes  place 
regularly,  and  removes  every  foreign  substance  that  would  be  calculated 
to  trouble  it.  They  act  at  first  on  the  spirits  or  their  humors ;  they 
appease,  excite,  or  change  in  a  thousand  ways  their  fermentative  move- 
ment ;  in  this  way  they  produce  all  sorts  of  efi"eets  on  the  body,  the 
solids  of  which  they  modify  secondarily. 

Such  are  the  principal  traits  in  the  medical  doctrine  of  Willis.  The 
reader  must  have  remarked  what  I  announced  in  the  commencement, 
that  they  resemble  very  much  those  of  Lebo,  in  certain  connections, 
and  diifer  from  them  in  others.  The  system  of  AVillis  was  more  vast, 
complicated  and  subtile  than  the  preceding,  was  less  comprehensive  to 
the  vulgar,  and,  therefore,  pleased  better,  minds  accustomed  to  abstract 
speculation  ;  but  there  are  at  bottom  the  same  defects,  and  it  merits  the 
same  reproaches.  The  English  nosologist  made  no  more  account  of  the 
form  and  constitution  of  the  solid  parts,  than  did  the  nosologist  of 
Leyden.  Nor  did  he  keep  any  better  the  promise  he  made  not  to  go 
beyond,  in  his  speculations,  the  limits  of  sensible  phenomena :  he  pre- 
sents to  us,  on  the  contrary,  a  series  of  deductions  purely  fictitious, 
resting  on  materials,  placed,  for  the  most  part,  beyond  our  senses.  I 
am  then,  compelled,  in  order  to  justify,  in  the  eyes  of  posterity,  the 
reputation  of  this  great  practitioner,  to  repeat  what  I  have  said  in 
favor  of  Sylvius  and  so  many  others,  namely :  that  they  laid  aside  their 


520  REFORM   PERIOD. 

fictitious  theories  when  visiting  the  sick,  and  consulted  their  experience 
only.  I  have  the  more  reason  to  think  that  Willis  acted  in  this  way 
from  what  he  says  on  the  subject  of  Peruvian  bark,  whose  eiFects  con- 
tradict his  theory — that  it  is  better  in  every  case  to  be  guided  by 
observation. 

The  disciples  of  these  two  celebrated  men  made  some  secondary  mod- 
ifications in  their  systems,  of  which  it  would  be  useless  here  to  give  a 
sketch  ;  I  therefore  pass  at  once  to  another  class  of  theoreticians. 


ART.  IV.    lATRO-MECHANICS. 

The  progress  of  chemistry  had  given  rise  to  the  idea  of  explaining 
the  functions  of  organized  beings  by  the  laws  which  regulate  the  inti- 
mate and  elementary  combinations  of  crude  bodies  ;  so,  also,  the  pro- 
gress of  experimental  physics,  mechanics,  and  mathematics,  suggested 
the  thought  of  applying  mathematical  calculations  to  the  phenomena  of 
the  living  economy.  They  were  vainly  filled  with  the  hope,  that  they  could 
arrive  to  the  determination,  with  mathematical  precision,  of  the  least 
vicissitudes  in  health,  as  well  as  the  means  to  remedy  them  ;  and  to  this 
purpose  they  devoted  themselves  to  patient  and  ingenious  researches. 

Sanctorious  was  the  first  who  entered  upon  this  path,  in  essaying  to 
estimate  by  exact  experiments  the  quantity  of  insensible  perspiration 
that  exhales  from  the  body  in  a  given  time.  As  all  the  functions  of  the 
organism  are  so  bound  together  that  no  one  can  be  deranged  without  the 
others  becoming  afiected,  he  thought  that  each  variation  in  the  quantity 
of  exhaled  vapor  would  indicate  a  sha<le  of  change  in  the  general  state 
of  the  body.  This  opinion  had  nothing  in  itself  very  unreasonable  or 
unreal ;  nevertheless,  the  researches  attempted  in  this  sense,  by  Sanc- 
torious, and  by  many  other  observers  of  the  greatest  merit,  only  pro- 
duced results  more  curious  than  useful,  and  consequently  have  been 
abandoned  on  account  of  the  little  benefit  which  has  accrued  to  the 
Healing  Art. 

Alphonso  Borelli,  professor  of  Mathematics  in  the  University  of  Pisa, 
member  of  the  Academy  del  Cuiiento,  instituted  in  1657,  by  Leopold, 
prince  of  Tuscany,  for  the  purpose  of  propagating  the  doctrine  and  method 
of  Galileo,  is  the  veritable  founder  of  the  sect  of  latro-mathematicians.  It 
was  in  the  halls  of  that  academy  that  he  read  his  first  essays  on  the 
mechanics  of  animals.  Soon  after  he  quitted  Pisa,  from  some  particular 
discontent,  and  went  at  first  to  Messina,  where  he  did  not  long  remain,  on 
account  of  the  political  troubles  that  agitated  Sicily ;  lastly,  he  went 
to  Pkome,  where  he  was  welcomed  and  protected  by  Christina,  ex-queen 


THEORIES   AND   SYSTEMS.  521 

of  Sweden,  to  whom   he   dedicated   his   famous   treatise   on   Animal 
Mechanics. 

Fruit  of  patience  and  genius,  this  work  created  a  new  department  in 
Medicine.  Until  then,  in  fact,  only  vague  and  erroneous  ideas  were 
held,  on  the  sum  of  the  forces  expended  hj  animals  in  their  movements, 
and  on  the  mode  of  employment  of  the  same  forces.  Proceeding  from 
the  principle  that  nature  attains  her  ends  by  the  most  direct  route  and 
the  most  simple  means,  it  had  always  been  thought  that  men  and  ani- 
mals are  constituted  in  a  way  to  be  able  to  execute  great  movements 
and  carry  heavy  burdens  by  employing  the  least  possible  force.  Borelli 
refuted  this  idea  by  convincing  arguments,  founded  on  anatomy  and  the 
laws  of  statics.  Comparing  the  bones  put  in  play  by  the  muscles,  to 
levers  moved  by  cords,  he  proved  that  man  expends  an  enormous 
quantity  of  power  in  his  movements.  If,  for  example,  there  be  attached 
a  weight  of  twenty-six  pounds  to  the  extremity  of  the  hand,  the  arm 
being  extended  horizontally,  and  then  be  brought  to  a  state  of  flexion, 
the  biceps  muscles  must  employ,  he  says,  to  execute  this  movement,  a 
power  which  will  not  be  less  than  eleven  hundred  and  sixty  pounds.* 
The  street  porter,  having  on  his  shoulders  a  package  of  one  hundred 
and  twenty-nine  pounds  weight,  consumes,  according  to  the  calculations 
of  the  same  author,  a  sum  of  forces  equal  to  17,266  pounds,  when  he 
sustains  himself  on  one  foot  alone. 

However  it  may  be  in  regard  to  the  exactness  of  these  calculations, 
which  must  be  accepted  only  as  a  very  elastic  approximation,  it  is 
unquestionable  that  a  man  developes,  in  his  movements,  a  muscular 
energy  incomparably  greater  than  the  weight  he  sustains  ;  a  truth 
which  was  not  supposed  before  the  publication  of  the  discoveries  of 
Borelli.  His  work  embraces,  besides,  a  prodigious  quantity  of  fine  and 
new  observations  on  the  various  modes  of  rest  and  locomotion  of  animals, 
such  diiferent  attitudes  as  standing,  sitting,  or  lying  down,  walking, 
running,  leaping,  swimming,  flying,  etc.  To  give  only  one  example  in 
a  thousand,  he  presents  a  very  ingenious  explanation  of  the  process  by 
means  of  which  a  bird  sustains  itself  while  sleeping,  resting  on  one  foot 
only,  and  supported  by  a  frail  branch  moved  by  the  wind. 

It  was,  then,  not  without  reason  that  this  author  writes  at  the  head 
of  his  preface:  "I  undertake  to  speak  on  the  mechanism  of  animals, 
an  arduous  subject,  which  a  great  number  of  ancients  and  moderns  have 
attempted,  but  which  they  merely  touched.  Not  one  of  them  has  as 
yet  suspected  the  numerous  and  interesting  problems  that  belong  to 
it,  much  less  resolved  them  by  rigorous  demonstrations."     He  developes 

"DeMotu  Animalium,  chap,  x,  prop.  35. 


522  REFORM   PERIOD. 

then  the  plan  of  his  work  in  these  words:  "This  treatise  will  be 
divided  into  two  parts ;  in  the  first,  we  shall  examine  the  visible  move- 
ments of  animals,  which  are  affected  by  the  alternate  flexion  and  exten- 
sion of  the  exterior  parts.  =••■'  '••'  "  In  the  second,  we 
shall  search  for  the  cause  of  muscular  movements,  and  all  internal 
movements,  such,  for  example,  as  the  progression  of  liquids  in  the  ves- 
sels and  viscera." 

The  first  part,  as  may  be  judged  by  the  above  compte-rendu,  has  all 
the  perfection  that  comports  with  the  lights  of  the  age,  and  merits 
eulogy.  The  second  has  not  obtained  as  unanimous  an  approval,  though 
it  was,  in  the  eyes  of  the  author,  the  most  essential,  and  had  cost  him 
more  pains,  more  calculations  and  researches  than  the  preceding.*  It 
includes  a  complete  physiological  theory,  a  summary  of  which  we  now 
proceed  to  give. 

One  of  the  fundamental  theorems  of  this  theory  is  that  by  which 
Borclli  explains  the  intimate  or  immediate  cause  of  muscular  contrac- 
tion. There  occurs,  he  says,  a  continual  flux  of  the  nervous  fluid,  and 
of  the  blood,  into  the  spongy  cellules  of  the  muscles.  Now,  when  the 
sensitive  soul,  which  resides  in  the  brain,  wishes  to  employ  the  motive 
faculty,  it  communicates  a  simple  excitement  to  the  nerves,  or  rather,  it 
pr  jects  throughout  the  nervous  tubes  a  subtile  fluid,  called  animal 
spirits.  In  an  instant,  the  mixture  of  the  nervous  juice  and  the  san- 
guineous liquid  which  impregnates  the  muscular  vescicles  is  put  in  ebul- 
lition, and  in  expanding  distends  the  muscular  mass,  the  extremities  of 
which  are  forced  to  approach  each  other.  Our  author  devotes  three  long 
chapters  to  the  development  of  this  theorem,  which  is  the  corner  stone 
of  his  physo-pathic  edifice.  He  compares  the  efi'ect  of  the  animal  spirit 
on  the  mixture  of  the  nervous  juice  and  blood  which  fills  the  muscular 
areolge,  sometimes  to  the  spark  that  flies  when  the  steel  strikes  the  flint ; 
again,  the  flame  excited  by  friction  ;  or  the  vapor  which  escapes  when 
water  is  thrown  on  quick-lime  ;  or  the  effervescence  produced  when  cer- 
tain acids  are  poured  into  alkaline  solutions,  etc.f 

But  in  vain  does  he  accumulate  subtilties  and  metaphors ;  all  the 
artifices  of  language  could  not  change  a  hypothesis  into  a  veritable  fact. 
Now,  no  observation  has  established  that  any  humor  flows  through  the 
extremities  of  the  nervous  fibrilloe,  nor,  for  a  much  stronger  reason, 
that  this  humor  mingles  with  the  blood  in  the  muscular  interstices,  or 

''  This  subject  has  been  studied  anew,  first  by  the  illustrious  P.  J.  Barthez,  in 
his  work,  Nouvelle  Mecanique  des  Movements  deFHomme  etdcs  Animaux;  then 
Iby  G.  and  E.  Weber,  intheirTraitc  dela  Mecanique  des  Organs  de la  Locomotion, 
.translated  from  the  German,  by  Jourdan. 

f  Le  Motu  Animalium. 


THEORIES   AND   SYSTEMS.  523 

of  an  effervescence,  instigated  by  the  animal  spirit.  What  shall  we 
think,  now,  of  the  calculation  which  this  author  pretends  to  establish,  of 
the  expansive  force  of  the  nervo-sanguineous  molecules,  which,  are 
supposed  to  fill  the  muscular  interstices  V  Need  we  be  astonished,  that 
proceeding  from  this  fictitious  idea,  he  arrives  at  such  ridiculous  and 
exaggerated  results  as  the  following,  viz :  that  the  heart  overcomes,  at 
each  contraction,  a  total  resistance  equivalent  to  the  weight  of  180,000 
pounds ! 

He  regards  stomachal  digestion  as  a  simple  trituration,  which  is 
sometimes  facilitated  by  the  concurrence  of  a  corrosive  ferment.  He 
explains,  in  a  manner  entirely  mechanical,  the  nutrition  of  parts,  or 
assimilation.  The  humors,  he  says,  as  well  as  the  solids,  allow  portions 
of  their  substance  to  escape,  which  evaporate  by  transpiration,  and  form 
little  spaces  at  the  points  from  which  the  particles  are  detached.  The 
sanguineous  globules,  pressed  with  violence  by  the  heart  and  arteries, 
become  engaged  in  these  little  lacunjB.  But  all  the  globules  do  not  enter 
indiscriminately  into  all  the  interstices  ;  each  globule  insinuates  itself 
into  a  vacuole,  whose  configuration  is  analogous  to  its  own ;  thus,  the 
osseous  globules  penetrate  the  pores  of  the  bones  only ;  the  fleshy 
globules,  into  those  of  the  flesh  ;  the  membraneous,  into  the  pores  of 
the  membranes,  etc.,  so  that  each  tissue,  receiving  the  aliment  which  is 
appropriate  to  it,  is  nourished,  and  repairs  its  losses. 

All  the  secretions  are  explained,  in  this  system,  in  the  same  way  as 
as  the  nutrition.  See,  for  instance,  how  he  represents  the  formation  of 
the  urine.  The  blood  being  projected  with  force  through  the  emiilgent 
arteries,  comes,  on  one  hand,  in  contact  with  the  orifices  of  the  san- 
guineous capillary  tubes,  on  the  other,  with  the  orifices  of  the  urinary 
canals :  suddenly  its  molecules,  united  by  simple  apposition,  separate,  as 
in  passing  through  a  sieve — the  aqueous  globules  of  the  urine  passed 
into  the  proper  renal  tubes,  whose  configuration  is  analogous  to  theirs, 
the  sanguineous  globules  insinuate  themselves  into  the  veins  that  are 
conveniently  disposed  to  receive  them,  and  can  not  give  passage  to  the 
urinary  globules.  "  Certainly,"  exclaims  our  mechanical  physiologist, 
"  as  well  have  faith  in  dreams  and  delusions,  as  to  imagine  that  there 
exists  a  magnetic  virtue,  and  particular  ferment,  endowed  with  a  very 
subtile  discernment,  and  placed  there  expressly  in  the  kidney,  to  separate 
the  urinary  from  the  sanguineous  molecules,  and  dispose  each  of  them 
in  their  appropriate  reservoirs  !  " 

According  to  him,  respiration  is  not  for  the  purpose  of  introducing  a 
new  principle  into  the  blood,  but  to  moderate  the  raging  passion  of  the 
vital  spirit,  in  about  the  same  way  as  the  balance  wheel  of  a  clock 
regulates  the  movement  of  all  the  wheels  by  its  alternate  oscillations. 


524  KEFORM    PERIOD. 

Kespiration  has  also  for  an  object,  to  give  to  the  sanguineous  globules, 
which  have  been  changed  during  their  passage  through  the  various  parts 
of  the  body,  their  primitive  and  normal  form. 

PATHOLOGY  AND  THERAPEUTICS. 

These  two  branches,  so  important  for  medical  science,  have  a  very 
small  consideration  in  the  work  of  Borelli ;  they  are  merely  mentioned, 
en  passant. 

This  writer  attributes  all  the  painful  sensations  to  the  itching  or 
irritation  of  the  fibrillated  extremities  of  the  nerves.  He  assures  us 
that  fever  is  produced  by  the  acridity,  or  by  the  fermentation  of  the 
nervous  juice  which  is  diffused  in  the  cellules  of  the  tissue  of  the  heart, 
and  he  adds,  that  this  acridity  of  the  nervous  juice  proceeds  either  from 
irritation,  or  from  obstruction  of  the  radicles  of  the  nerves,  which  arc 
distributed  in  the  glands,  and  principally  in  those  of  the  mesentery. 

The  fever  decreases  and  becomes  calm,  according  to  him,  when  the 
blood,  projected  with  force  into  the  glandular  organs,  has  sufficiently 
washed  and  carried  off  the  viscid  or  corrosive  matters  which  obstruct 
the  nervous  radicles.  But  after  an  indefinite  time,  the  excrementitial 
residue,  deposited  in  the  glandular  cavities,  occasions  a  new  development 
of  viscous  and  acrid  matter,  which  excites  a  second  paroxysm  ;  such  is 
the  cause  of  the  periodical  return  of  the  febrile  accessions. 

The  definite  cure  depends  on  the  complete  elimination  of  the  febrigin- 
ous  ferment ;  this  elimination  is  efi"ected  by  insensible  transpii'ation,  or 
by  the  sweat  or  urine  on  some  other  emunctory.  If  the  fever  is  of  a 
benign  nature,  it  is  equally  cured,  whatever  may  be  the  method  of  cure 
employed  ;  if  it  is  of  a  malignant  character,  every  species  of  treatment 
will  fail ;  thus,  then,  the  surest  part,  in  all  cases,  is  to  attempt  nothing 
without  an  urgent  necessity.  If,  however,  we  judge  it  proper  to  do 
something,  it  should  be  remembered  that  during  the  fever  the  principal 
indication  consists  in  dissipating  the  obstruction  of  the  excretory  vessels. 
and  in  tempering  the  acrimony  of  the  febrifacient  ferment,  by  the  intro- 
duction of  a  salt  of  an  opposite  nature. 

If  we  did  not  know  ali'eady  what  to  think  of  a  medical  doctrine  based 
on  a  theorem  so  hypothetical,  it  would  be  sufficient,  by  considering  the 
poverty  of  the  curative  indications  which  were  deduced  from  it,  to  declare 
it  insufficient  and  erroneous.  Without  attempting  to  make  apparent  all 
the  nonsense  and  contradictions  it  embraces,  I  shall  content  myself  with 
asking :  By  what  experiment  has  any  one  established  the  obstruction  of 
the  venous  radicles,  which  was  supposed  to  be  the  cause  of  so  many 
diseases  ?  How  is  it  that  Borelli,  after  ridiculing  those  who  admitted 
the  presence  of  a  particular  ferment  in  each  secretory  gland,  had  recourse 


THEORIES   AND   SYSTEMS.  525 

to  the  intervention  of  a  febrifacient  ferment  to  explain  the  generation  of 
fever?  etc.,  etc. 

This  theory,  although  as  little  founded  in  reason,  as  that  of  the  iatro- 
chemists,  presents  itself  under  a  much  more  attractive  and  scientific 
dress.  It  rests  on  extremely  delicate  considerations  in  anatomy  and 
hydraulics — on  calculations  which  it  would  be  extremely  difficult  to 
verify,  and  still  more,  to  contradict,  which  lends  to  it  an  air  of  mathe- 
matical precision,  to  which  no  other  system  of  medicine  could  aj)proach. 
It  renewed  the  ingenious  idea  of  Asclepiades  of  Bythinia,  on  the  atoms, 
their  shapes,  their  continued  passage  through  the  pores,  and  the  obsta- 
cles that  accidentally  arrest  them  ;  but  it  drew  these  ideas  from  recent 
microscopic  observations,  which  resembled  demonstrations.  In  fine,  it 
gave  rise  to  the  hope  that  it  would  be  possible,  some  day,  to  represent  by 
algebraic  formulae,  all  the  combinations  of  the  vital  forces,  and  all  the 
rules  of  the  Healing  Art. 

Vain  illusion,  which  was  calculated  to,  and  did  seduce  many  eminent 
minds,  among  whom  I  will  mention  for  Italy,  Laurent  Bellini,  a  cotem- 
porary  of  Borelli,  and  member,  like  him,  of  the  society  del  Cimento ; 
George  Baglivi,  surnamed  the  Pioman  Hippocrates  ;  Joseph  Dauzellini : 
for  France,  Bossier  de  Sauvages,  the  first  of  nosologists ;  J.  Senac,  whom 
Morgagni  scarcely  ever  mentioned  without  giving  to  him  the  epithet  the 
great ;  for  Germany  and  Holland,  Herman  Boerhaave,  the  propagator  of 
clinical  teaching ;  John  Bernouilli,  who  shares  with  Xewton  and 
Leibnitz  the  glory  of  the  invention  of  the  differential  calculus ;  in 
Great  Britain,  Archibald  Pitcairn,  who  proposed  nothing  less  than  the 
solution  of  this  vast  problem :  "  A  disease  being  given,  find  the  remedy  ; 
James  Keill,  who  joined  the  Newtonian  attraction  to  the  mechanical  prin- 
ciples of  Borelli ;  John  Freind,  who  continued  the  history  of  Daniel 
Leclerc ;  Eichard  Mead,  celebrated  by  the  nobility  of  his  character,  as 
well  as  by  the  variety  of  his  learning. 

The  limits  of  this  work  do  not  permit  me  to  indicate  all  the  changes 
which  the  iatro-mechanical  doctrine  underwent  by  the  pens  of  so  many 
distinguished  men.  Besides,  those  details  have  lost  very  much  of  their 
interest  since  the  doctrine  has  fallen  into  complete  discredit.  It  will 
sufiice  to  notice  the  principal  phases  through  which  it  passed  during  its 
short  and  brilliant  career. 

George  Baglivi,  a  native  of  Eagusa,  being  left  an  orphan  at  an  early 
age,  was  adopted  by  one  of  his  relatives,  who  was  a  physician,  and 
gave  him  his  first  instructions.  He  received  the  doctor's  hat  at  the 
University  of  Salerno,  or  Padua ;  afterward,  he  traveled  throughout 
Italy  to  hear  the  most  famous  professors.  At  Bologna,  he  followed  the 
anatomical  course  of  the  illustrious  Malpighi.     Finally,  he  located  at 


526  REFORM   PERIOD. 

Eome,  wliere  he  devoted  himself  to  the  practice  of  Medicine,  and  very- 
soon  acquired  a  great  reputation  for  skill.  The  pope,  Clement  XL, 
immediately  conferred  upon  him  the  chair  of  Theoretic  Medicine  in  the 
college  of  Sapientia ;  afterward,  that  of  Anatomy  and  Surgery,  which 
Lancisi  had  just  left  for  a  more  elevated  station.  Though  young,  Bag- 
livi  showed  himself  worthy  to  succeed  such  a  predecessor,  and  sustained 
the  eclat  of  the  chair.  His  renown,  already  European,  increased  every 
day,  when  he  was  arrested  in  the  middle  of  his  career  by  a  long  and 
painful  disease,  by  which  he  was  lost  to  science  on  the  17th  of  June, 
1707,  in  the  thirty-eighth  year  of  his  age. 

Baglivi  endeavored  to  complete  the  theory  of  Borelli,  by  applying 
it  to  pathology  and  therapeutics,  which  the  latter  had  barely  touched. 
He  comprehended  very  well  that  the  physicians  of  his  time,  whether 
Galenists  or  latro-chemists,  were  so  entirely  occupied  with  the  study  of 
humors  as  to  neglect  very  greatly  the  examination  of  the  solids ;  con- 
sequently, he  proposed  to  redirect  his  cotemporaries  to  the  study  of  the 
latter,  by  demonstrating  that  the  solids  have  a  great  preponderance  over 
the  humors  in  all  the  organic  functions,  whether  in  health  or  disease. 
"  Full  of  this  opinion,"  he  says,  "  I  devoted  myself  entirely  to  the 
observation  of  the  symptoms  during  life,  and  to  the  study  of  the  ana- 
tomical lesions  after  death,  and  I  have  been  convinced  by  my  own  eyes, 
that  the  influence  of  the  solids  is  greater  than  that  of  the  li(|uids,  even 
in  the  generation  of  diseases."'-' 

He  admits  for  the  simple  or  primitive  fiber,  only  two  orders  of  affec- 
tions: one  proceeding  from  an  excess  of  relaxation  or  softening,  the 
other  from  an  excess  of  tension  or  rigidity.  This  hypothesis  was 
renewed  by  Themison,  and  is,  in  short,  that  on  which  all  the  Solidist 
theories  rest,  which  pretend  to  go  beyond  the  sensible  phenomena.  He  dis- 
tinguishes two  orders  of  fibers,  namely :  the  fleshy  fiber,  which  has  its 
origin  in  the  heart,  and  constitutes  the  muscles,  tendons,  bones,  and  lig- 
aments ;  second,  the  membraneous  fiber  which  is  derived  from  the  men- 
inges of  the  brain,  and  serves  to  form  the  membranes,  vessels,  glands, 
and  other  tissues.  Consequently,  he  recognized  also  two  motor  princi- 
ples in  the  animal  economy,  namely :  the  heart,  which  gives  impulsion 
to  fleshy  parts,  by  sending  to  them  a  liquid  without  which  their  fibers 
could  not  be  nourished  or  act,  and  the  brain,  whose  envelopes  give 
impulse  to  the  movement  and  life  of  all  the  membranes  and  viscera. 

The  manner  in  which  Baglivi  conceived  the  influence  of  the  encepha- 
lic meninges  has,  according  to  my  view,  no  merit  for  originality,  and  is 

*■' Specimen  quntuor  Libroruui  dc  Fibra  JNIotrice  et  Morbosa.  Auimadversiones 
in  Theoricem  Veterem,  sec.  ii. 


THEORIES   AND   SYSTEMS.  527 

not  worth  tlie  trouble  of  contesting  with  him  its  invention.  This  phy- 
siologist, in  comparing  the  structure  and  functions  of  the  dura  mater 
with  the  structure  and  functions  of  the  heart,  finds  between  them  a  per- 
fect analogy.  He  further  says,  that  as  the  central  organ  of  circulation 
projects  the  blood  into  all  parts  of  the  body,  through  the  arterial  canals, 
so  also  the  dura  mater  embraces  closely  the  brain  in  its  movements  of 
systole  and  diastole,  and  expresses  a  fluid  which  it  causes  to  flow  to  the 
utmost  extremities  of  the  nerves.  He  gives  next  an  explanation  no 
less  odd,  of  sympathetic  phenomena ;  according  to  him,  the  oscillations 
of  the  dura  mater  extend  by  continuity  of  tissue  to  the  nerves, 
to  the  membranes  and  viscera  in  general,  and  to  the  heart  itself :  in 
their  turn,  the  particular  movement  of  each  organ  tending  the  same 
way,  reflects  itself  in  some  sort  upon  the  brain;  hence  the  manifestation 
of  a  universal  sympathy,  a  constant  undulation  from  the  encephalic  cen- 
ter to  the  periphery  of  the  b  Ay,  and  from  the  periphery  to  the  center. 
A  simple  observation  destroys  this  whole  scafiblding  :  it  has  been  avered 
that  the  dura  mater  has  no  sensible  movement  in  itself;  those  that  are 
seen,  proceed  either  from  the  impulsion  of  the  heart  and  arteries,  or  from 
■  the  influence  of  respiration  on  the  venous  circulation  of  the  brain. 
Moreover,  the  pretended  continuity  of  tissue  of  the  meninges  with  the 
other  membranes,  vessels,  and  viscera,  is  purely  visionary. 

If  Baglivi  merits  our  remembrance  by  his  theoretic  dissertations  only, 
we  should  not,  perhaps,  occupy  our  time  with  this  notice  ;  but  he  has 
more  solid  titles  to  our  attention.  His  treatise  on  Practical  Medicine 
was  remarkable  for  qualities  not  common  at  that  epoch.  The  author 
gives  in  it  unceasing  counsel  to  be  guided  by  observation,  to  sacrifice 
the  arguments  of  theory  to  the  prescriptions  of  experience.  Here  we 
see  a  man  whom  the  prejudices  of  his  medical  education  sometimes  led 
astray,  but  who,  by  the  strength  of  reason  and  the  depth  of  his  genius, 
was  often  led  to  return  to  the  path  of  truth. 

He  does  not  show  himself  in  this  work  an  exclusive  partisan  of  Solid- 
icm  he  was  willing  to  acknowledge  that  chronic  afi'ections  might  pro- 
ceed from  a  cachochymy,  or  vice  of  the  humors.  He  was  also  led  to 
think  that  the  fevers  which  prevailed  in  Home  during  the  summer, 
originated  in  an  alkaline  excess,  as  they  are  frequentlyjugulated  in  the 
outset  by  acidulous  drinks.  He  protested  against  the  custom  of  many 
physicians  of  his  time,  who  prescribed  alkaline  solutions,  tinctures,  and 
volatile  salts  in  acute  inflammatory  diseases.  All  that  class  of  anti- 
acids  augments,  as  he  thought,  the  acridity  and  impetuosity  of  the 
blood,  the  dryness  of  the  tongue,  thirst,  insomnia,  headaches,  general 
heat,  and,  in  a  word,  exasperated  all  the  symptomatic  features  of 
inflammation. 


528  REFORM   PERIOD. 

He  pronounced  a  very  wise  judgment  on  the  manner  in  which  we 
should  appreciate  the  ancients  and  moderns.  "  I  have  seen,"  he  says. 
"in  some  academies,  men  so  prejudiced  against  the  ancients,  that  they 
feared  it  would  degrade  their  intelligence  to  devote  a  little  time  and 
trouble  to  read  the  works  of  the  Galenist  writers.  They  preferred  to 
torment  their  minds  miserably,  in  order  to  imagine  something  new  and 
unheard  of;  and  if  by  accident  they  encountered  something  of  the  kind, 
they  think  they  have  great  claims  upon  science — enough  for  their  glory. 
Others,  on  the  conti-ary,  were  so  religiously  attached  to  the  opinions  of 
antiquity,  that  they  unceasingly  criticised  modern  discoveries,  however 
fine  or  useful  they  may  be."* 

Again  he  says:  "Medicine  is  not  a  production  bursting  suddenly 
from  the  genius  of  man,  but  is  the  child  of  time.  In  old  times  it  was 
believed  to  be  an  inspiration  from  the  gods,  but  it  can  be  said  with 
more  truth,  that  it  is  the  fruit  of  observations  collected  from  age  to  age, 
for  a  great  number  of  centuries.  Those  who  pretend  that  experience 
and  reason  are  opposed  to  each  other,  seem  to  me  to  be  rambling  ration- 
alists and  Empirics."  This  last  sentence  is  a  trait  of  genius,  a  ray  of 
light  which  the  author  himself  very  soon  abandons,  but  which  we  must 
keep  in  view;  no,  reason  and  experience  are  not  two  opposing  authori- 
ties which  condemn  each  other,  and  all  medical  doctrines  which  do  not 
satisfy,  at  the  same  time,  both  of  these  modes  of  acquisition,  are  mani- 
festly defective. 

Baglivi,  despairing  of  being  able  to  resolve  such  a  problem,  that  is  to 
say,  to  put  practice  and  theory  in  agreement,  essayed  to  draw  between 
them  a  line  of  demarkation,  by  assigning  to  each  its  department — an 
enterprise  inconsistent  on  the  part  of  a  man  who  had  declared  that 
reason  and  experience,  or  in  other  words,  theory  and  practice,  should 
always  go  together.  "  It  is  proper,"  he  says,  "  for  the  theorist  to  give 
reasons  for  the  apparent  phenomena  of  diseases — to  compare  past 
circumstances  with  the  present — to  scrutinize  the  hidden  causes  of 
morbid  accidents,  and  the  true  origin  of  the  causes  themselves — to 
develop,  in  fine,  all  that  relates  to  the  subject,  so  that  the  physician 
may  appreciate  clearly,  and  with  precision,  the  curative  indications ; 
but  it  belongs  to  the  practitioner  to  arrange  the  history  of  diseases — to 
pronounce  on  the  appropriateness  of  remedies,  and  the  indications  to 
fulfil,  and  to  judge  by  the  light  of  experience  all  that  relates  to  the 
cure  of  diseases.  Whoever  shall  act  differently,  and  pretend  to  submit 
the  rules  of  practice  to  the  principles  of  theory,  will  obtain  no  success 
in  the  treatment  of  diseases." 

*  Opera  Omnia  Medica.    Pref. 


THEORIES   AND   SYSTEMS.  529 

No  one  could  contradict  himself  more  openly  than  Baglivi  has  done, 
in  the  passages  we  have  just  quoted  ;  but  this  must  not  astonish  us — 
on  the  contrary,  we  must  expect  to  see  these  contradictions  frequently 
renewed,  for  as  soon  as  an  eminent  logician  leaves  the  true  route,  he 
has  more  difficulty  than  any  other  to  re-enter  it — the  chain  of  his  ideas 
leads  him  always  straight  forward  in  the  track  on  which  he  has  entered. 
Here  is  another  remarkable  example  of  the  contradictions  of  this  author, 
in  the  portrait  he  has  drawn  of  the  Empiric  sect :  "  This  sect,"  he 
says,  in  one  place,  "  banishes  from  medicine  all  theories,  and  even  every 
species  of  reasoning,  and  follows  experience  only,  in  the  cure  of  diseases  ; 
not  an  experience  guided  by  reason,  and  multiplied  proofs,  but  a  stupid 
experience,  guided  by  accident,  and  worthy  of  market  houses  only. 
This  sect  introduced  so  many  absurdities  into  medicine,  that  the  Art 
would  have  been  destroyed  if  Galen,  about  the  first  century  of  the 
Christian  era,  had  not  raised  a  dyke  to  oppose  that  torrent  of  errors, 
and  founded,  with  as  much  courage  as  prudence,  the  Eational  sect,  on 
an  immovable  basis." 

Farther  on,  this  same  author  holds  a  very  difi^ercnt  language :  "  The 
Rational  sect,"  he  says,  "  persecuted  with  hatred  the  Empirics,  describ- 
ing them  as  vile,  and  unworthy  of  cultivated  minds,  and  fit  only  for 
the  populace  in  market  places.  I  should  approve  of  their  conduct  if 
by  Empiricism  they  meant  the  method  of  stupid  and  blind  experimen- 
tation, not  subjected  to  repeated  tests — not  matured  by  reflection,  in 
sKort,  serving  only  as  a  basis  of  false  inductions  and  monstrous  precepts. 
But  I  can  not  agree  with  them,  if  they  had  in  view  a  rational  or  learned 
Empiricism,  the  fruit  of  method,  not  of  hazard,  directed  and  fructified  by 
intelligence,  and  aspiring  to  the  highest  truths  by  the  attentive  and  per- 
severing observation  of  sensible  phenomena.  Such  an  Empiricism  has 
obtained  in  all  time  the  approbation  of  enlightened  men,  who  strove  to 
increase  it,  as  a  mode  of  acquisition  conformable  to  our  nature." 

In  many  other  passages  still,  the  Pvoman  Hippocrates  emits  an  opinion 
favorable  to  Empiricism,  only  one  more  of  which  I  will  give  :  "Accord- 
ing to  Pliny,  we  are  ignorant  of  what  makes  us  live  ;  but,  if  I  dare 
give  my  opinion,  we  are  much  more  ignorant  of  what  makes  us  sick ; 
for  the  infinitessimal  substance  that  gives  the  first  and  immediate 
impulse  to  disease,  is  entirely  incomprehensible.  How,  then,  in  the 
midst  of  so  much  obscurity,  can  we  deduce  the  therapeutical  indica- 
tions ?  I  avow,  that  in  so  much  embarrassment,  the  testimony  of  the 
senses  is  our  only  refuge  ;  in  other  terms,  it  is  necessary  to  have  observed 
long  and  patiently,  by  what  process  nature  engenders  disease — how  she 
effects  the  coction  and  separation  of  the  peccant  humor — then  establish, 
on  this  base,  a  curative  method,  which,  following  nature  step  by  step, 


530  KEFORM   PERIOD. 

never  loses  sight  of  the  injurious  or  useful  effects  of  the  remedies. 
Now,  it  is  important  in  this  task  that  reason,  so  much  vaunted  by 
physicians,  submit  itself  to  Empiricism — to  that  Empiricism  which 
letters  have  polished,  which  several  series  of  observations  have  con- 
firmed, and  which  intelligence  vivifies  by  its  light ;  for  the  aid  which 
theory  alone  promises  us,  swells  at  first  our  hopes,  und  then  leaves  us 
in  perplexity." 

Hermann  Boerhaave  was  endowed  with  a  comprehensive  and  subtile 
mind.  Profoundly  versed  in  the  writings  of  the  ancients,  and  no  less 
familiar  with  all  the  works  of  moderns,  he  undertook  to  unite  in  one 
body,  the  doctrines  of  all  the  branches  of  medical  science,  and  to  con- 
ciliate among  them  the  reigning  theories  of  his  times.  He  was  eclectic, 
after  the  manner  of  Galen  and  Fernel ;  but  as  the  mechanical  explana- 
tions predominate  in  his  writings,  he  has  been  classed  among  the  latro- 
mechanics,  the  same  as  Galen  and  Fernel  are  classed  among  the  Dog- 
matists. After  the  example  of  these  he  divided  his  entire  course  on 
Medicine,  or  his  Institutes,  into  five  parts,  which  are,  physiology,  pathol- 
ogy, semeiotics,  hygiene,  and  therapeutics.  The  first  part  forms,  alone, 
two-thirds  of  the  work ;  so  that  the  four  following  occupy,  each,  but  a 
small  space,  and  embrace  only  a  general  view  of  the  matters  of  which 
they  treat. 

Physiology  being  then  the  most  complete  part  of  this  course  on  medi- 
cine, we  proceed  to  take  a  rapid  view  of  it.  He  represents  the  action 
of  the  stomach  or  food  as  follows:  "If  you  consider  that  the  food»is 
continually  diluted  by  a  great  quantity  of  saliva  which  flows,  unceas- 
ingly, from  the  mouth  and  the  esophagus,  into  the  stomach,  and  by  the 
humor  which  transudes  the  coats  of  the  stomach  itself ;  that  these  are 
mingled  and  agitated  with  the  rest  of  the  food,  which  has  been  previ- 
ously taken — that  their  most  intimate  parts  are  moved  by  the  action  of 
the  air,  which  is  ground  up,  if  I  may  say  so,  with  it,  and  that  all  this 
is  augmented  by  the  heat  of  the  organ :  you  can  conceive  that  the  eftect 
of  the  concave  part  of  the  velvet  tunic,  is  to  dilute,  macerate,  swell, 
attenuate,  and  produce  the  commencement  of  fermentation,  putrefaction, 
rancidity,  and  the  solution  of  food,  and  fit  them  for  a  change  into  a 
nature  similar  to  that  of  the  humors  of  our  body.  You  do  not  yet  com- 
prehend by  this  how  the  stomach  can  digest  the  solid  food  which  has 
been  but  slightly  masticated.  But  to  find  the  cause  which  we  seek,  cast 
your  eyes  on  the  muscular  structure  of  the  stomach  and  see  what  action 
depends  on  it.      "  •■■'     In  several  animals  the  digestion  is  almost 

wholly  accomplished  by  the  sole  contractile  movement  of  the  stomach — 
a  movement  which  is  so  considerable  that  it  is  heard  and  felt." 

We  see  here  a  very  skillful  amalgam  of  ideas  drawn  from  anatomy, 


I 


THEORIES   AND   SYSTEMS.  561 

physics,  and  chemistry.  The  rest  of  the  doctrine  of  Boerhaave  offers 
throughout  the  same  assemblage  of  ideas,  and  for  that  reason  I  shall 
not  multiply  the  quotations.  I  will  add  only  the  following,  to  show 
how  much  the  greatest  minds  are  liable  to  be  deluded  in  regard  to 
theories,  and  to  take  for  demonstrated  truths  the  simplest  conjectures. 
"The  fluid  which  has  been  filtered,"  he  says,  "through  the  corticle  sub- 
stance of  the  brain  and  cerebellum  is  pressed  continually  by  the  action 
of  the  heart  and  arteries  into  the  nerves,  and  by  means  of  the  nervous 
canals  into  all  parts  of  the  body,  forming  a  circulation  as  real  and  as 
constant  as  that  of  the  blood  and  the  lymph.  This  humor  is  so  simple, 
so  mobile,  and  so  perfectly  volatile,  that  it  has  been  called  the  nervous 
spirit,  and  is  sub-divided  into  natural,  vital,  and  animal.  But  as  the 
secretion  of  these  spirits  is  never  interrupted,  as  it  is  constantly  sup- 
plied anew,  in  order  to  repair  what  is  lost  or  consumed,  it  appears  that 
those  which  have  fulfilled,  entirely,  their  purposes,  pass  from  the  last 
filaments  of  the  nerves  into  the  small  lymphatic  veins,  by  which  they 
are  carried  into  other  veins  a  little  larger,  then  into  the  common  lym- 
phatic vessels,  whence  they  flow  to  the  heart  by  the  sanguiferous  veins, 
and  thus  this  subtile  fluid  circulates,  incessantly,  in  its  vessels,  like  the 
other  humors."" 

In  his  writings  on  practical  Medicine,  Baglivi  abandons  theories,  or 
pays  but  little  attention  to  them,  and  advises  to  rely  entirely  upon 
experience.  Boerhaave,  on  the  contrary,  does  not  appear  to  doubt  for  a 
single  instant  the  exactness  of  his  theoretic  speculations,  and  endeavors 
to  base  upon  them  all  the  phenomena  of  diseases,  and  all  the  rules  of 
Art.  Herein  he  shows  himself  a  more  I'efined  dialectitian,  but  a  poorer 
observer  than  the  Eoman  Hippocrates.  The  latter  appears  to  me  to 
have  more  depth  and  genius  ;  he  rises,  often,  above  the  prejudices  of  his 
medical  education  and  of  his  age ;  he  sheds  frequently  brilliant  light 
in  the  midst  of  his  contradictions.  The  other  had  a  larger  mind  and 
more  extended  erudition  ;  he  adopts  the  teachings  of  his  masters  as 
infallible  dogmas,  and  appears  to  have  no  other  ambition  than  to  co-or- 
dinate and  conciliate,  and  to  unite  them  into  a  complete  system.  He 
says  in  one  of  his  first  aphorisms,  that  the  study  of  pathology  must  be 
commenced  in  the  most  simple  affections,  those  of  which  we  have  the 
clearest  idea,  which  are  the  easiest  to  heal,  and  the  knowledge  of  which 
is  indispensable  for  the  understanding  of  other  diseases.  Xow,  accord- 
ing to  him,  the  diseases  of  the  primitive  fiber  are  those  which  fullfil 
these  conditions  in  the  highest  degree,  as  may  be  seen  in  the  following 
passage : 

*  Instit.  Med. 


532  REFORM   PERIOD. 

"  The  primitive  fiber,"  he  says,  "  is  comiDOsed  of  small  simple  teiTes- 
trial  particles,  separated  from  the  fluid  contained  in  the  vessels.  They 
are  reciprocally  applied  to  each  other  by  the  forces  of  life,  in  such  a 
way  that  the  perturbating  causes  which  exist  in  the  living  body  are 
scared}'  able  to  change  or  alter  their  nature.  On  this  account,  each 
molecule  in  particular  is  not  subject  to  any  disease  that  physicians  have 
seen  or  treated  ;  but  the  smallest  fiber  which  results  from  the  reunion 
of  these  molecules  is  subject  to  the  following  diseases:  excess  of  soft- 
ening or  relaxation,  excess  of  tension  or  elasticity.  "'••■^ 

Thus  the  professor  of  Leydea  favors  us  with  the  afi'ections  of  the 
microscopic  molecules  of  which  the  pi-imitive  fiber  is  composed,  while 
no  physician  up  to  this  moment  has  seen  or  treated  any  aifection  of  this 
order.  In  regard  to  diseases  of  the  fiber  itself,  he  shows  thera  to  us  in 
their  smallest  details,  so  well  that  we  could  scarcely  doubt  that  lie  had 
seen  them  and  followed  them  in  all  their  phases.  Now,  as  no  one 
before  or  since  has  pointed  out  this  class  of  diseases,  it  must  be  thought 
that  Boerhaave  has  seen  the  marvellous  things  which  he  recounts  above, 
with  a  particular  microscope,  or  rather  with  the  eyes  of  faith. 

Let  us  then  turn  away  from  these  microscopic  diseases,  on  which  it 
is  impossible  to  establish  any  reasoning,  and  come  to  diseases  more  cog- 
nizable— inflammation,  for  example.  If  we  define  inflammation,  with 
the  surgeons,  an  affection  characterized  by  heat,  pain,  and  redness, 
accompanied  often  with  tumefaction,  and  followed  nearly  always  by  an 
abnormal  secretion,  there  is  no  one  who  may  not  in  a  moment  form  a 
clear  idea  of  this  disease ;  and  who,  in  seeing  scurvy,  or  erysipelas,  or 
phlegmon,  or  erythema,  or  a  simple  labial  herpes,  could  not  say,  from 
the  preceding  definitions,  that  they  are  inflammations.  It  would  not 
ref|uire,  afterward,  a  great  effbrt  of  the  imagination  to  suppose  that  this 
ensemble  of  phenomena,  to  which  we  give  the  name  of  inflammation, 
phlogosis,  or  phlegmasia,  may  take  place  internally  as  well  as  externally. 
This  conjecture  becomes  a  probability,  if  in  certain  diseases  of  internal 
organs,  such  as  the  stomach  or  intestines,  the  patient  realizes  a  sensa- 
tion of  heat  and  pain,  similar  to  that  felt  in  external  phlegmasia.  The 
probability  augments  still  more,  if  the  natural  secretion  of  the  suffer- 
ing organs  is  altered,  augmented,  or  diminished,  etc.,  etc.  In  this  way, 
it  seems  to  me,  we  may  proceed  from  the  known  to  the  unknown,  from 
perfectly  apparent  phenomena  to  those  which  are  only  partially  so,  or 
which  manifest  themselves  only  by  their  connection  with  other  sensible 
phenomena. 

Boerhaave  did  not  proceed  in  this  way,  as  is  plain  from  the  extracts 

"  Aphorisms. 


THEORIES   AND   SYSTEMS.  533 

we  have  already  given  fi-om  his  writings,  and  also  hy  those  which  we 
now  proceed  to  add.  Phlogosis,  he  says,  consists  in  the  stagnation  of 
the  arterial  blood  in  the  smaller  vessels,  is  agitated  and  pressed  by  the 
rest  of  the  blood,  whose  force  and  quickness  are  increased  by  the  fever. 
It  may  be  developed  in  the  extremities  of  the  sanguineous  arteries,  or 
in  the  sero-lymphatic  vessels,  or  in  other  arterioles  more  attenuated  still ; 
which,  not  being  able  to  transmit  the  red  globules  or  other  grosser  parts 
of  the  fluids  which  have  penetrated  into  their  cavities  by  the  dilatation 
of  their  orifices.         '•'         "  The  capillary  vessels,  which 

are  barely  visible,  augment  in  volume  and  are  distended  with  blood,  and 
form  a  red  tumor.  Their  parieties,  formed  of  small  fibrillre,  are  on  the 
point  of  rupture,  which  causes  the  severe  pain.  The  solids  and  liquids 
acting  and  reacting  on  each  other,  produce  the  hardness  and  resistance. 
Finally,  the  liquid  globules  flowing  through  the  now  obstructed  vessels, 
break  against  the  tumor,  and  it  is  this  mutual  attrition  of  the  liquids 
and  solids  that  causes  the  heat  and  the  itching.  Who  can  comprehend 
these  transcendental  explanations  ?  For  myself,  I  avow  that  I  under- 
stand nothing  that  is  said  there,  or  rather,  I  see  that  friction,  on  which 
every  one  may  think  and  write  what  he  pleases. 

If  from  phlogosis,  considered  in  general,  that  is,  from  an  abstraction 
made  from  the  tissue  in  which  it  is  developed,  we  pass  to  the  examina- 
tion of  phlogosis  in  particular,  that  of  the  lungs,  for  example,  we  shall 
always  find  the  same  defects  in  the  descriptions  of  this  author.  He 
carries  us  constantly  from  observation  into  the  field  of  hypothesis. 
"  When  the  vessels  of  the  lung  are  attacked  with  inflammation,  it  is 
called  peripneumonia.  Those  of  the  vessels  which  may  bo  invaded  by  the 
phlogosis  are  the  bronchial  and  pulmonary  arteries,  and  their  lymphatic 
collaterals.  Thus,  we  may  conceive  of  two  species  of  peripneumonia  ; 
one  of  which  is  located  in  the  pulmonary  arteries,  the  other  in  the 
extremities  of  the  bronchial  arteries." 

Doubtless  we  may,  in  our  minds,  distinguish  these  two  si)ecies  of 
peripneumonia,  and  others  also  ;  but  where  is  the  observer  who  has  ever 
discerned  them  on  the  living,  or  even  the  dead ;  and,  therefore,  I  ask,  of 
what  practical  value  is  a  purely  ideal  division,  which  none  of  our  senses 
can  apprehend?  Let  us  recall  our  fourth  philosophic  axiom,  which, 
among  other  things,  says  that,  if  it  is  important  to  make  distinctions,  it 
is,  perhaps,  still  more  important  not  to  make  too  many ;  and  that  we 
must  not  multiply  divisions  any  further  than  is  necessary  to  regulate  us 
in  the  use  of  the  things  relative  to  our  wants.  Xow  it  is  clear  that  the 
distinction  of  these  two  pneumonias,  sidmitted  by  Boerhaave,  is  not  only 
useless,  but  also  inappreciable  in  practice. 

After  the  death   of   the  celebrated  professor  of  Leyden,    the  iatro- 


S34  REFORM   PERIOD. 

mechanical  doctrine  rapidly  fell.  At  this  time  it  exists  only  in  history, 
and  in  some  parts  of  physiology.  Others  succeeded  it,  to  disappear,  also, 
soon  after,  or  submit  to  considerable  modifications,  so  rapid  was  the 
movement  of  ideas  during  the  historic  period  which  we  have  just 
reviewed. 


ART.    V  .     ANIMISM    A  X  D    VITALISM. 

"While  the  teaching  of  the  professor  of  Leyden  shed  such  a  glaring 
light  over  the  medical  world,  and  disseminated  widely  his  mechanico- 
chemical  doctrine,  two  other  professors,  less  celebrated  than  he,  and  less 
profound,  but  more  attentive  and  faithful  observers  of  nature,  laid  the 
foundation  of  new  theories,  destined  to  take  the  place  of  his  brilliant 
system.  One  was  Frederic  Hoffman — the  other  George  Ernest  Stahl. 
Both  had  been  fellow  students  in  the  University  of  Jena,  and  now  found 
themselves  colleagues  in  the  risiDg  school  of  Halle,  on  which  they  drew, 
for  half  a  century,  the  attention  of  the  learned  world. 

Stahl,  of  whom  we  shall  speak  in  the  first  place,  belongs  not  less  to 
the  history  of  chemistry  than  to  that  of  Medicine,  by  his  discoveries 
and  his  writings ;  but  in  this  work  we  can  only  occupy  ourselves  with 
his  medical  opinions.  He  was  physician  to  the  court  of  Weimar  in 
1694,  when  he  was  called  to  the  University  of  Halle,  on  the  recommen- 
dation of  his  old  fellow  student,  Hoffman,  who  showed  by  this  circum- 
stance, all  the  generosity  of  his  soul ;  for  he  was  not  ignorant  that  he 
made  himself  a  rival,  whose  doctrine  differed  much  from  his  own,  and 
whose  renown  might  cast  him  in  the  shade. 

The  new  professor  responded  fully  to  the  opinion  that  had  been  formed 
of  him,  by  acquitting  himself  with  a  zeal  and  exactitude  that  never  belie 
the  arduous  functions  of  a  professorship.  More  inclined  to  observe  and  to 
meditate  than  to  read,  he  showed  a  somewhat  affected  disdain  for  classic 
erudition,  though  he  attempted  to  cover  his  defect  of  literary  culture  by 
some  quotations  from  ancient  authors,  and  by  the  insertion  of  a  quan- 
tity of  Greek  words  in  his  Latin  periods.  He  may  be  excused  for 
having  often  presented  the  ideas  of  others  as  his  own,  by  alledging 
his  slight  erudition  ;  but  nothing  can  justify  the  epithets  of  contempt 
which  he  lavishes  on  his  scientific  adversaries.  His  principal  title  to 
glory  in  Medicine,  is  for  having  recalled  the  attention  of  his  cotempora- 
ries  to  the  natural  tendencies  of  the  animal  economy — to  the  reaction  of 
the  vital  forces — or  the  soul — in  diseases — a  reaction  and  tendencies 
which  the  physico-chemical  doctrines  too  much  lost  sight  of. 

In  the  first  place,  he  says,  it  should  be  understood  what  life  is — in 


THEORIES  AND  SYSTEMS.  535 

what  it  consists,  essentially — what  is  its  principal  seat — what  end  it  sub- 
serves, and  its  final  destination.  Afterward,  it  should  be  well  understood 
what  constitutes  health,  and  the  signs  by  which  it  may  be  recognized,  in 
order  to  know  under  what  circumstances  the  practice  of  the  Art  is  useful 
or  necessary.'-'  Now  life,  according  to  Stahl,  is  nothing  else  than  the 
conservation  of  the  humors  of  the  body  in  a  state  of  integrity  and  per- 
fect mixture,  notwithstanding  their  very  marked  tendency  to  putri- 
faction — a  tendency  which  is  rapidly  developed  as  soon  as  they  are 
withdrawn  from  the  influence  of  the  vital  force.  It  is  in  this  respect 
that  the  living  body  is  distinguished  from  inanimate  bodies,  or  simple 
compounds.  "  We  must  never,"  he  exclaims,  a  little  farther  on,  "loose 
sight  of  that  disposition  according  to  which  the  mixtures  of  the  liquids 
precede  the  structure  of  the  parts ;  so  that  there  is  not,  in  the  animal 
economy,  any  organ  or  tissue,  which  does  not  presuppose  the  fluid  mole- 
cules, the  reunion  of  which  has  served  to  form  them." 

We  have  seen  the  latro-chemists  present  fermentation  as  the  essen- 
tial and  primitive  phenomenon  of  life, — the  latro-mechanics  attribute 
that  prerogative  to  muscular  contraction ;  but  now  we  see  another 
physiologist  who  regards  the  pi*eservation  of  the  humors  in  a  state  of 
integrity  and  perfect  mixture  as  the  primordial  and  characteristic  act  of 
a  living  being.  Others  will  come  still,  who,  proceeding  from  a  new 
point  of  view,  will  accord  preeminence  to  other  phenomena.  They  all 
forget  that  sentence  of  Hippocrates,  confirmed  by  G-.  Baglivi :  "  The 
human  body  has  no  determined  commencement.  Each  of  its  integral 
,  parts  may  be  regarded  equally,  as  the  first  or  the  last ;  for  in  a  described 
circle,  it  is  impossible  to  find  either  beginning  or  end."f  Neither  do 
they  remember  better  that  sentence  which  forms  our  sixth  philosophic 
aphorism.  "  What  is  called  essential  or  non  essential  is  related  strictly 
to  our  ideas  and  our  wants.  All  the  qualities  of  each  individual,  con- 
sidered in  itself,  are  equally  essential,  in  the  sense  that  they  all  proceed 
from  its  essence  and  its  nature,  and  it  is  not  therefore  exact  to  say  that 
certain  of  its  attributes  are  more  essential  than  others."| 

After  having  defined  in  his  way  the  essence  of  life,  by  saying  that  it 
consists  in  the  preservation  of  the  mixtures  of  the  humors,  the  professor 
of  Halle  asks  what  is  the  primitive  agent  or  principle  of  this  funda- 
mental act  ■?  and  endeavors  to  prove  that  it  cannot  be  anything  else 
than  the  immaterial  and  rational  soul.  He  forms  from  this  view  two 
arguments :  the  first  is  drawn  from  the  final  destination  of  the  human 
body,  which  has  only  been  created,  according  to  him,  as  an  instrument 

°  Doctrinse  Medicae  Theoricte  part  i.,  PhjsiologitB  de  Vita  et  Sanitate. 
"j"  Hippocrates  on  K-egions  in  Man. — Baglivi  de  Fibra  Motrice. 
J  Locke's  Essay  on  the  Human  Understanding,  Book  III,  cli.  iv. 


536  REFORM   PERIOD. 

for  the  soul.  "  It  must  be  remembered,"  he  says,  "  the  human  mind 
could  do  nothing  in  this  world  without  the  intermediation  of  the  body, 
for  which  it  is  intended.  Its  functions  consist  in  the  acquisition  of 
knowledge,  and  the  exercise  of  voluntary  acts.  It  cannot  put  itself  in 
relation  with  sensible  things,  nor  have,  consequently,  any  idea  but  by 
the  aid  of  material  organs.  It  cannot,  either,  manifest  and  execute  its 
purposes  except  by  the  same  organs.  It  is  also  very  evident,  that  the 
body  is  subjected  to  the  soul,  since  it  employs  it  both  in  acquiring  know- 
ledge and  accomplishing  its  purposes." 

The  second  argument  that  Stahl  proposes  is  still  more  subtile.  "  The 
act,"  he  says,  "by  means  of  which  life  is  sustained,  and  the  soul  fulfils 
its  functions,  is  absolutely  repugnant  to  matter,  and  agrees  well  with 
the  nature  of  the  mind.  That  act,  as  observation  shows,  is  motion :  by 
it  the  mixture  of  the  humors  is  preserved  in  integrity  ;  the  soul  acts  on 
the  body  and  in  the  body  ;  compares,  reasons,  and  moves  from  one  object 
to  another  ;  in  a  word,  it  is  in  perpetual  motion.  Now,  all  motion  is  an 
immaterial  act,  which  can  only  have  for  a  principle  an  immaterial  sub- 
stance itself."  On  this  our  physiologist  rested  without  knowing  it,  or 
at  least  without  saying  so,  on  an  axiom  of  Descartes,  who  accords  to 
matter  no  other  essential  property  than  extension,  and  who  requires  for 
the  production  of  any  motion,  the  direct  or  indirect  impulsion  of  a  spir- 
itual agent. 

Stahl,  in  supposing,  with  Descartes,  that  all  motion  requires  the  aid 
of  a  spiritual  motive  agency,  affirms  a  thing  which  our  common  obser- 
vation contradicts,  every  moment.  In  fact,  we  see  constantly  produced 
around  us  and  in  us,  movements  which  no  one  is  tempted  to  attribute  to 
a  spiritual  agency.  Besides,  it  is  well  demonstrated  that  our  informa- 
tion, in  regard  to  physical  things,  cannot  go  beyond  our  sensations,  and 
our  sensations  can  learn  nothing  concerning  the  presence  or  absence  of  a 
spiritual  being. 

Thus  considered,  the  opinion  of  Stahl  on  the  first  motor  influences  of 
the  animal  economy,  has  only  the  value  of  an  hypothesis ;  but  compared 
with  the  opinions  emitted  in  advance  of  him,  on  the  same  subject,  this 
hypothesis  has  the  advantage  of  being  more  simple  and  less  unrcasona- 
able.  It  may  be  therefore  said,  literally,  that  the  physiologist  of  Halle 
triumphs,  when  he  puts  his  hypotheses  in  comparison  with  those  of  his 
predecessors. 

"  Those  who  first  assigned  to  the  human  heart  other  active  principles 
besides  the  rational  soul,  imagined  two  more  souls,  each  endowed 
with  a  certain  degree  of  discernment,  by  means  of  which  they  were  sup- 
posed to  execute  their  functions  with  order,  measure  and  propriety. 
They  named  the  one  vegetative,  and  the  other  sensitive." 


THEORIES   AND   SYSTEMS.  537 

•*  Those  who  hold  to  the  opinion,  more  ancient  still,  which  allows  in  man 
only  a  single  intelligent  and  rational  soul,  of  a  nature  superior  to  that 
of  brute,  charged  with  inferior  as  well  as  with  the  most  exalted  func- 
tions, from  the  plausible  reason  that  what  accomplished  the  highest,  can 
perform  the  lowest  things,  disfigure  that  doctrine,  otherwise  very  sen- 
sible, by  the  addition  of  numerous  energies  or  abstract  faculties,  which 
they  transform  by  a  figurative  language  into  so  many  real  entities,  which 
execute  certain  special  functions  under  the  direction  of  the  soul.  Such 
is  the  origin  of  digestive  attraction,  plastic  assimilation,  and  other 
faculties  which  play  so  important  a  part  in  Galenic  physiology." 

"  It  was  much  worse,  when,  deluded  by  that  absurd  axiom,  that  there 
can  exist  no  connection  between  an  immaterial  substance  and  matter, 
the  physicians  invented  a  host  of  spirits,  a  species  of  beings  extremely 
subtile,  serving  as  intermediaries  between  the  soul  and  the  body.  Although 
so  gross  a  fiction  that  children  now  could  not  be  imposed  upon  by  it,  it 
received  so  much  favor,  that  the  spirits  were  regarded  as  the  servants 
or  emissaries  of  the  soul ;  their  rapidity  was  compared  to  light,  and 
realizing  more  and  more  this  fiction,  they  ended  by  saying,  that  a  spirit 
was  a  luminous  substance.  Van  Helmont  replaced  these  spirits 
by  the  archeus,  or  archei ;  but  while  the  soul  was  denied  to  have 
effective  power,  they  accorded  to  the  spirits,  or  archei,  the  knowledge  of 
the  functions  which  devolved  upon  them,  and  the  power  to  fulfil  them." 

After  having  proved  that  neither  chemical  ferments,  nor  the  shape  of 
liquid  molecules,  nor  the  configuration  of  vascular  orifices,  are  sufficient 
to  explain  the  secretions  and  excretions,  he  adds,  "  We  must  say 
as  much  of  this  invention  of  some  moderns,  who  assume  that  particles 
destined  to  be  secreted  exert  a  special  irritation  on  the  secretory  organs, 
in  such  a  way  that  each  of  these,  by  contracting  itself,  expresses  and 
rejects  the  humor  which  is  appropriate  to  it.  But,  besides  the  oddity 
of  this  fiction,  which  represents  to  us  mechanical  instruments,  suscep- 
tible of  irritation,  experience  contradicts  such  an  hypothesis.  Thus,  the 
urine,  after  much  drinking,  is  passed  more  frequently,  freely  and  abun- 
dantly, and  at  the  same  time  is  less  dense  and  more  watery ;  when, 
on  the  other  hand,  it  is  more  charged  with  salts,  or  in  other  words,  more 
irritant,  it  is  passed  less  frequently,  and  in  a  smaller  quantity, 
which  is  contrary  to  the  supposition  above  stated." 

Others  have  better  developed,  than  Stahl,  the  influence  of  the  physical 
upon  the  moral  man,  but  no  one  has  made  so  sensible  the  influence  of 
the  moral  upon  the  physical  man.  He  gives  some  very  curious  exam- 
ples concerning  the  effects  of  the  passions  and  habits  on  the  vital 
acts.  He  explains,  very  naturally,  the  birth-marks  on  children 
{ncevi  malerni),  by  the  sympathy  which  exists  between  the  soul,  or  the 
34 


538  REFORM   PERIOD. 

imagination,  of  the  mother,  and  the  soul  of  the  fetus.  In  fine,  he 
concludes,  from  all  these  physiological  considerations,  whether  general 
or  particular,  that  it  is  the  soul  which  presides  directly,  and  without 
any  intermediary  agency,  over  the  organization  of  the  body,  from  the 
moment  of  the  fecundation  of  the  germ,  and  it  continues  to  direct  all 
its  functions  until  death. 

Let  us  hasten  to  repeat  a  sentence  which  we  have  already  proclaimed, 
that  all  these  transcendental  speculations  of  ancient  and  modern  physi- 
ologists, on  the  final  destination  of  the  human  body,  or  on  its  first 
movement,  or  on  the  primordial  phenomena  that  commence  the  circle  of 
animal  life — all  these  speculations,  I  say,  appertain  rather  to  philoso- 
phy than  to  medicine — they  have  not  advanced  a  single  line  the  Healing 
Art.  I  repeat,  there  is  not  a  single  one  of  the  hypotheses  emitted  on 
such  subjects,  which  are  not  connected  with  absurd  or  injurious  prac- 
tical consequences,  which  is  the  cause  of  the  legitimate  repugnance 
which  practitioners  feel  for  all  the  physiological  systems  that  rest  upon 
assumptions,  without  the  pale  of  observation,  and  loads  them  to  refuse  to 
discuss  them,  otherwise  than  by  the  practical  conclusions  that  flow  from 
them ;  imitating  in  this  way  the  mode  of  reasoning  of  the  mathemati- 
cians, who,  when  the  data  of  a  problem  conduct  them  necessarily  to  an 
absurd  conclusion,  conclude  from  this  that  they  are  insufficient,  or 
badly  laid  down. 

Let  us  see,  then,  what  are  the  practical  consequences  of  Animism. 
The  author  of  the  system,  himself,  deduces  them  from  it,  in  these  terms : 
"  if  the  movements  of  the  animal  economy  depart,  in  any  respect,  from 
the  normal  mode,  then  the  physician  should  understand  that  it  is  his 
duty  to  calm  them,  or  to  excite  them,  or  to  restrain  them,  in  a  word,  to 
act  upon  them  conformably  to  the  natural  indications.  It  is  of  the 
highest  importance  to  him,  to  have  constantly  in  view  the  natural 
synergy  of  the  soul,  in  order  to  show  himself  the  minister,  rather  than 
the  governor:  in  other  words,  the  physician  should  study  to  follow  the 
movements  and  tendencies  of  nature,  rather  than  to  believe  himself 
ruthorised  to  dare  attempt  something,  without  having  due  regard  to 
her  tendencies." 

Such  a  maxim  made  a  fundamental  rule  of  therapeutics,  and,  rigor- 
ously observed,  is  nothing  else  than  the  absolute  negation  of  the  active 
concurrence  of  the  physician  in  the  treatment  of  diseases  ;  it  is  to  limit 
the  functions  of  the  man  of  the  Art  to  a  lazy  contemplation  of  the 
sufferings  of  the  patient.  If  it  was  true  as  Stahl  taught,  that  every 
pathological  affection  was  the  result  of  the  reaction  of  the  soul  against 
the  morbific  agent :  if  the  totality  of  the  symptoms  of  a  disease  only 
represent  the  succession  of  vital  movements,   designedly  put  in  action 


* 


THEORIES   AND   SYSTEMS.  539 

by  a  rational  agent,  for  the  purpose  of  effecting  a  cure,  could  he  do  bet- 
ter in  any  case  than  remain  a  spectator  of  the  struggle  in  which  he 
could  take  no  part,  without  running  the  reasonable  risk  of  deranging 
the  wise  combinations  of  the  supreme  regulator  of  the  economy  ? 

Let  no  one  accuse  me  of  exaggerating  the  consequences  of  the  tliera- 
peutical  axiom  of  Stahlism.  Many  philosophers  and  physicians  before 
me  have  deduced  them  in  equivalent  terms  ;  they  have  likewise  advised 
that  nothing  be  done  in  most  diseases  ;  to  await  patiently  till  nature 
surmounts  the  difficulty,  which  advice  is  easier  to  give  than  to  follow^  and 
which  fejv  physicians  put  in  practice,  even  of  those  who  proclaim  its 
excellency.  The  only  active  succor  that  the  physicians  and  the  assist- 
ants may  attempt,  according  to  tliis  doctrine,  consists  in  giving  to  the 
patient  what  he  may  desire,  and  furnishing  him  the  means,  as  much  as 
possible,  of  satisfying  his  instinctive  appetites,  which  are  supposed  to 
indicate  the  tendencies  of  the  organism,  or  to  be  the  appeal  of  nature. 
Those  who  reason  thus  forget  that  art  was  invented  only  on  account  of 
defects  and  frequent  errors  of  instinct,  and  to  bring  aid  to  this  insuffi- 
cienc3\  This  is  a  fact  that  has  been  established  by  all  medical  histo- 
rians, and  that  I  have  sufficiently  amply  discussed  in  the  first  volume 
to  make  it  evermore  an  element  of  the  science.'--'  Nevertheless,  there 
are  many  diseases  that  are  cured  by  the  natural  forces  only.  Then  the 
functions  of  the  physician  are  limited,  effectively,  to  the  prevention  of 
imprudences,  so  that  nothing  be  done  rashly.  Now  the  latro-chymici 
had  too  greatly  lost  sight  of  this  truth,  which  Stahlism  reminded  them 
of  by  exaggerating  it. 

The  doctrine  of  pure  Animism  spread  rapidly,  particularly  in  Ger- 
many, but  beyond  that  region  it  made  very  little  progress ;  the  theory  of 
the  vital  principal  which  is  very  analogous  to  it  was  generally  preferred, 
especially  in  France,  but  it  differed  from  it  in  several  important 
respects ;  for  the  vital  principle  of  the  moderns  resembles  much  more 
the  sensitive  soul  of  the  ancients  or  the  archeus  of  Van  Helmont,  than 
the  immaterial  soul  of  the  Stahlians.  Barthez,  the  founder,  or  at  least 
the  eloquent  defender  of  the  doctrine  of  the  vital  principle,  carries  it 
back  to  the  plilosophy  of  Plato,  and  even  to  the  dogmas  of  Pythagoras. 
He  recognises  it  in  the  writings  of  Francis  Bacon,  and  more  distinctly 
still,  in  those  of  Van  Helmont.  The  latter,  according  to  him,  is  among 
all  moderns  the  one  who  has  indicated  the  greatest  number  of  phe- 
nomena which  announce  in  man  a  vital  principle,  distinct  from  the 
body  and  the  mind,  and  yet  endowned  with  sensation  and  perception.f 

''  See  the  Primitive  Period  in  this  History. 

t  Nouveaiix  Elements  de  la  Science  de  rHomme.     Second  Ed.  Paris,  1806. 


540  REFOKM    PERIOD. 

Now  if  we  demand  of  Barthez  what  is  tlie  nature  of  that  vital  prin- 
ciple, he  responds:  it  is  neither  an  extremely  subtile  matter,  interme- 
diate between  the  soul  and  the  body,  nor  a  pure  spirit,  nor  a  simple 
modality  of  organized  matter.  "  Frederic  Hoffman,"  he  says,  "  and 
other  celebrated  authors,  have  pretended  that  the  principle  of  life  which 
animates  a  man  is  of  a  medium  nature  between  the  soul  and  the  body  ; 
but  this  middle  being  is  one  of  reason,  for  we  cannot  pass  by  gradations 
from  the  body  to  the  immaterial  soul,  and  the  essential  nature  of  these 
two  substances  causes  them,  necessarily,  to  exclude  each  other.  The 
principle  of  life  whose  functions  are  exercised  in  the  human  body,  must 
be  conceived  by  means  of  ideas  entirely  distinct  from  those  by  which  we 
apprehend  the  nature  of  the  body  and  the  thinking  soul." 

It  appears,  nevertheless,  very  difficult  to  admit  the  existence  of  an 
active  principle,  which  may  be  neither  a  spirit,  nor  a  body,  nor  a  subtile 
fluid  intermediate  between  the  soul  and  the  body,  nor  a  simple  attri- 
bute, or  property  of  matter.  The  vital  principle  of  Barthez,  if  we  may 
believe  him,  is  none  of  these  things,  but  is  somewhat  related  tu  each  ; 
it  is  an  inconceivable  amphibological  being,  something  less  than  an 
hypothesis,  for  it  is  a  doubt.  Hear,  now,  the  celebrated  professor  of 
Montpellier  develop  this  singular  doctrine.  "  We  can  only  give,"  he 
says,  "  negative  assertions,  doubts,  and  conjectures,  on  the  nature  of 
the  vital  principle  of  man.  It  is  useful  to  develop  the  skepticism  of 
these  considerations,  in  order  to  study  more  surely  the  forces  and  affec- 
tions of  this  principle."  A  little  farther  on  he  adds,  "  I  observe,  espe- 
cially, that  it  is  useless  to  discuss,  as  may  be  done  in  following  ordinary 
ideas,  whether  the  vital  principle  in  man  is,  or  is  not,  a  substance ; 
because  it  seems  to  me  impossible  to  give  a  clear  sense  to  the  word 
substance,  though  this  term  is  commonly  employed  in  metaphysics.  The 
question  which  I  should  ask  myself  in  this  section  is,  then,  solely, 
whether  the  principle  of  life  in  man  has  its  proper  and  individual 
existence,  or  whether  it  is  only  a  mode  inherent  to  the  human  body,  to 
which  it  gives  life  ?  " 

"  It  may  be  possible,  doubtless,  that,  according  to  a  general  law, 
established  by  the  author  of  nature,  a  vital  faculty,  endowed  with 
motior  and  sensitive  forces,  supervises,  necessarily,  (in  an  indefinable 
manner)  the  construction  of  matter,  of  which  each  animal  body  is 
formed,  and  which,  in  consideration  of  this  faculty  originates  subsequent 
movements,  necessary  to  animal  life,  in  all  its  duration.  But  it  may 
be,  also,  that  God  unites  to  the  combination  of  matter  which  is  given 
to  each  animal,  a  vital  principle,  which  subsists  hj  itself,  and  which 
differs,  in  man,  from  his  mind." 

I  say  it  with  regret,  more  absurdities  could  not  be  crammed  into  so 


THEORIES   AND   SYSTEMS.  54 1 

small  a  space.  What !  you  announce  that  you  will  not  discuss  whether 
the  vital  principle  in  man  is  a  substance,  or  not,  hut  that  you  are 
willing  to  inquire  whether  it  has  a  proper  and  individual  existence,  or 
if  it  is  only  a  mode  of  existence  inherent  to  the  human  body  !  Ah  ! 
do  3'ou  not  see,  that  it  is  the  same  question,  in  different  terms  ?  And 
then,  how  strangely  you  resolve  the  question  !  You  say  that  this  vital 
principle  might  be  only  a  modality  of  the  organic  body  ;  or  that  it 
might  also  have  its  proper  existence.  Here  is  a  solution  that  resolves 
absolutely  nothing.  Nevertheless,  Barthez  soon  quits  his  character,  as 
skeptic,  to  entertain  us,  throughout  two  volumes,  with  the  faculties, 
acts,  and  lesions,  of  the  vitil  principle.  He  speaks  of  it  no  longer  as 
of  an  equivocal  and  hypothetical  being,  but  as  of  a  real  and  very  active 
being,  endowed  with  proper  forces,  and  susceptible  of  modifications 
distinct  from  those  of  the  soul  and  the  body. 

He  attempts  in  vain,  in  the  conclusion,  to  return  a  little  to  the 
skepticism  he  announced  in  the  onset ;  his  penchant  for  the  realization 
of  the  vital  principle  is  observed  in  his  dubitable  phrases.  "  The  results 
on  the  death  of  men  are  as  follows;  first,  the  dissolution  of  the 
body ;  second,  the  extinction  of  the  forces  of  the  vital  principle ;  lastly,  the 
separation  of  the  soul.  =•■'  =■•'  «  As  is  sensible,  on  the  one  hand,  the 
metamorphosis  of  the  terrestial  part  of  man,  so  is  doubtful,  on  the  other 
hand,  the  fate  of  the  vital  principle  after  death.  If  this  principle  is 
only  a  faculty  united  to  the  living  body,  it  is  certain  that  at  the  destruc- 
tion of  the  body,  it  returns  into  the  system  of  forces  of  universal 
nature.  If  it  is  a  being  distinct  from  the  body  and  the  soul,  it  ma}"" 
perish  with  the  extinction  of  its  forces  in  the  body  which  it  animatea  ; 
but  it  may  also  pass  into  other  human  bodies,  and  vivify  them  by  a 
sort  of  metamorphosis.  ■•'  *  When  a  man  dies,  his  body  is  resolved 
into  its  elements ;  his  principle  of  life  reunites  with  that  of  the  uni- 
verse, and  his  soul  returns  to  God  who  gave  it,  and  who  secures  it  an 
immortal  existence." 

If,  setting  aside  the  radical  fault  with  which  the  system  of 
Barthez  is  stamped  from  its  origin,  we  follow  the  development  of  the 
system  into  the  particular  applications  which  the  author  has  made  of  it. 
we  shall  easily  convince  ourselves  that  no  other  has  furnished,  to  this 
day,  as  reasonable  explanations  on  most  of  the  phenomena  of  the  ani- 
mal economy,  whether  in  a  state  of  health  or  disease.  N"o  one,  for 
example,  has  explained  as  naturally  the  physiological  or  pathological 
sympathies  which  arc  manifested  in  a  multitude  of  individuals ;  sym- 
pathies which  are  often  very  strange,  very  surprising,  and  always  a 
useful  study  for  the  physician. 

But  it   is   especially  in   therapeutics,  that   touchstone  of   medical 


542  REFORM  PERIOD. 

doctrines,  where  Barthez  shows  himself  superior  to  all  the  theorists  of 
antiquity  and  modern  times.  Before  him,  only  the  two  following  axioms 
were  known  in  medical  practice  :  "  Diseases  arc  cured  by  their  contra- 
ries;" "  The  physician  is  the  minister  of  nature,  and  should  study. 
only,  to  follow  her  indications  and  tendencies." 

In  virtue  of  the  first  of  these  axioms,  the  latro-chemists  employed 
acidulated  drinks  to  correct  the  alkaline  acretions  of  our  humors,  and 
they  gave  alkaline  or  spirituous  drinks  to  correct  the  acid  accretions. 
The  latro-mechanics  made  use  of  incisives  and  operatives  to  unload  the 
vessels  or  their  obstructed  pores.  In  accordance  with  the  second  axiom, 
the  Hippocratists  and  Animists  observed  the  crisis,  and  extolled  the 
expectant  method.  For  these  two  axioms,  one  of  which  is  false,  as  we 
have  heretofore  demonstrated,  and  the  other  of  which  is  susceptible  of 
a  multitude  of  diverse  interpretations,  the  physiologist  of  Montpellier 
substituted  a  more  precise  and  philosophic  language. 

M.  Lordat,  the  depository  and  skillful  interpreter  of  the  thera- 
peutical doctrine  of  Barthez,  expresses  himself  as  follows  on  this  sub- 
ject ;  "  We  may  include  in  three  classes  all  of  known  therapeutical  meth- 
ods: the  first  comprises  the  natural  method,  the  second  the  analytical, 
and  the  third  the  empirical." 

"  I.  The  natural  methods  are  those  which  aim  to  favor,  to  accelerate, 
or  to  regulate  the  course  of  diseases  which  tend  toward  a  favorable  solu- 
tion. The  name  indicates  the  end  proposed,  viz :  to  aid  nature,  and 
render  her  operations  surer,  either  by  retarding,  hastening,  or  changing 
the  proportion  of  the  elementary  acts  which  she  employs. 

"  II.  The  analytical  methods  are  thohc  in  which,  after  having  decom- 
posed a  disease  into  the  essential  affections  of  which  it  is  the  product,  or 
into  the  simple  diseases  which  compose  it,  the  physician  attacks  directly 
these  elements  of  disease  by  means  proportioned  to  their  relations  of 
force  and  influence. 

"  These  methods,  as  well  as  those  which  will  be  discussed  in  the  fol- 
lowing article,  are  employed :  First,  when  nature  makes  no  Salutary 
effort ;  secondly,  when  she  acts  feebly  and  tardily,  so  that  her  efforts 
are  exhausting ;  and  lastly,  when  the  natural  movements  add  still  more 
to  the  gravity  of  the  disease. 

"  Thus,  to  give  an  example  of  the  decomposition  of  a  disease,  in 
most  catarrhs,  particularly  in  those  which  return  periodically,  Barthez 
finds :  first,  a  superabundance  of  serous  humors ;  second,  a  fluxionary 
movement  which  directs  them  especiall}'  toward  the  mucous  membranes 
of  the  nose  or  the  lungs ;  third,  a  modification  of  the  vital  actions  of 
those  membranes,  which  puts  them  in  harmony  with  the  other  elemen- 
tary acts,  and  leads  them  to  concur  to  the  same  end,  namely :  to  the 


THEOKIES   AND   SYSTEMS.  543 

excretion  of  redundant  humors,  but  which  may  degenerate  into  exces- 
sive irritation  or  into  atony. 

"  By  the  anal_)  tical  method,  all  the  symptoms  are  not  attacked  at 
once,  and  when  it  is  used,  equally  energetic  means  must  not  be 
employed  against  them  all.  The  great  art  is  to  choose  those  elements 
which  it  is  the  most  important  to  combat,  and  to  determine  the  order  in 
which  they  are  to  be  attacked. 

"  III.  \Ye  now  come  to  the  empirical  methods.  To  conceive  their 
spirit,  we  have  only  to  oppose  them  to  those  of  w'hich  we  have  first  spo- 
ken thus  far.  lu  the  natural  and  analytical  methods,  we  perceive  the 
mode  of  utility  of  tlie  means  employed,  i.  e.,  the  relation  of  the  indica- 
tions to  fulfill,  with  the  afl:"ections  and  the  immediate  results 
brought  about  by  these  means.  We  see,  for  example,  that  an  artificial 
flux,  occasioned  by  a  venesection,  or  by  other  attractives,  resolves  an 
inflammation  completely,  by  destroying  the  natural  flux,  which  enters 
into  the  constitution  of  that  disease.  "  ^  "^  The  empirical  methods 
are  those  whose  efficacy  has  been  established  by  experience,  but  whose 
immediate  and  primitive  efi'ects  have,  in  regard  to  the  cure  of  the  dis- 
ease, no  connection  that  our  minds  can  appreciate.  Barthez  recognises 
three  sorts  of  empirical  methods,  which  he  distinguishes  as  imitative, 
perturbative,  and  specific. "=••' 

The  following  method  of  considering  the  operation  of  therapeutics  is 
as  new  as  it  is  luminous  and  fruitful.  We  may  say  that  it  lays  the 
true  basis  of  the  philosophy  of  this  science,  and  includes  the  germ  of  a 
revolution  in  its  ideas  and  its  language.  The  new  methods  of  treat- 
ment which  Barthez  has  described  are  of  too  high  importance  to  be 
admitted  by  us  before  haviug  proved  them  in  the  crucible  of  severe  crit- 
icism. We  now  proceed,  therefore,  to  examine  them  in  succession,  with 
the  most  serious  attention. 

NATURAL     METHOD. 

This  method  aims,  says  one,  to  favor,  accelerate,  or  regulate  the  pro- 
gress of  diseases  which  have  a  favorable  tendency.  When  the  physician 
observes  that  a  disease  has  a  favorable  tendency,  he  can  do  nothing  bet- 
ter than  to  watch  its  progress,  in  order  to  obv'iate  the  untoward  changes 
that  may  ensue,  and  to  prevent  the  imprudences  that  the  patient  or  his 
friends  are  liable  to  commit.  The  epithet  natural,  given  to  this 
method  exclusively,  seems  to  me  inexact,  for  it  conveys  the  idea,  that 
we  follow  better  in  it  the  indications  of  nature  than  in  the  others,  which 
the  author,  doubtless,  docs  not  mean  to  say,  for  it  would  be  erroneous. 

'^M.  Lordat,  Exposition  de  la  Doctrine  Medicale  de  Barthez.     raris,  1818, 


544  REFOKM    PERIOD. 

There  exists,  in  fact,  no  metliod  of  treatment  which  does  not  rest,  or 
pretend  to,  at  least,  on  the  natural  indications  of  disease — on  the 
knowledge  of  their  symptoms,  course  and  tendencies.  The  particular 
method  which  is  now  in  question,  would  be  much  better  designated  by 
the  epithet  expectant,  which  many  writers  give  to  it.  This  last  expres- 
sion characterises  much  better  the  position  the  physician  assumes  in 
this  method,  and  creates  no  unfavorable  prejudices  against  the  other 
curative  methods  which  he  believes  it  proper  to  employ,  where  diflFerent 
indications  require  it.  The  expectant  method  is  convenient,  first,  when 
the  aflfections  tend,  spontaneously,  to  a  happy  termination  ;  second,  in 
new  aflPections,  not  well  understood.  It  has  been  recommended,  particu- 
larly by  the  Hippocratists  and  Animists. 

ANALYTIC     METHOD. 

This  method  is  perfectly  defined  and  developed  by  M.  Lordat.  "  It 
consists,"  says  this  writer,  "in  decomposing  a  disease  into  the  elemen- 
tary affections,  of  which  it  is  the  product — or  into  the  more  simple  dis- 
eases of  which  it  is  composed,  in  order  to  attack  separately  each  of  these 
elements,  by  means  proportionate  to  their  relations  of  force  and  influence. 
We  have  recourse  to  such  a  method  in  diseases  which  have  no  tendencies 
in  themselves  to  a  happy  termination,  and  which  we  cannot  cure  by  any 
direct  specific  medication." 

I  will  add  to  these  statements,  that  the  analytic  method  is  the  most 
difl&cult  in  application,  because  it  requires  more  investigation  than  all 
the  rest ;  namely,  the  decomposition  of  a  disease  under  treatment.  But, 
as  by  this  decomposition  our  minds  seem  to  get  a  more  intimate  knowl- 
edge of  the  circumstancss  of  the  disease,  and  to  penetrate  farther  into 
the  secret  operations  of  nature,  it  has  happened  that  several  writers 
have  called  the  analytic  method,  exclusively,  the  rational — a  very 
improper  designation,  because  it  conveys  the  idea  that  reasoning  is 
excluded  from  the  other  curative  methods,  or  that  there  is  less  reasoning 
in  them  than  in  this.  These  writers  measure  the  exactness  of  our  judg- 
ments by  the  labor  which  they  have  cost  us ;  they  resemble  a  mathema- 
tician, who  supposes  that  one  reasons  more  justly  in  transcendental 
geometry  than  in  arithmetic. 

The  third  method  which  this  author  describes,  is  designated  by  the 
term  empirical — but  it  must  be  granted  that  all  that  is  said  on  this 
subject  is  inexact — even  its  name.  In  fact,  the  word  empiric,  joined  to 
the  substantive,  method,  signifies  a  manner  of  treating  diseases  in  con- 
formity with  experience.  Now,  I  ask,  is  there  any  method  of  treatment 
which  must  not  be  established  both  on  experience  and  on  reason  ?  Let 
us  recall  that  sentence  of  Baglivi,  which  we  have  heretofore  quoted : 


I 


THEORIES   AND   SYSTEMS.  545 

"  Those  lolio  suppose  that  reason  and  experience  are  opposed  to  each 
other,  are  deceived ;"  and  we  must  conclude  from  this  that  nothing  is 
less  sensible  than  to  attempt  to  distinguish  one  curative  method  from 
others,  either  by  the  term  rational  or  empirical.  M.  Lordat  himself  has 
felt  the  impropriety  of  this  denomination,  for  he  adds,  a  little  further 
on:  "Eigorously,  all  the  modes  of  treatment,  considered  in  their  imme- 
diate effects  on  the  elementary  affections,  are  empirical,  because  the 
results  of  their  action  could  never  have  been  anticipated."  But  instead 
of  rejecting  an  improjier  expression,  which  leads  to  a  confusion  of  ideas, 
he  endeavors  to  justify  it  by  a  sophism. 

How  has  it  happened  that  Barthez,  having  discovered  a  curative 
method  founded  upon  analysis,  or  the  decomposition  of  a  disease  into 
elementary  affections,  did  not  conceive  of  another,  founded  on  synthesis, 
that  is,  on  the  consideration  of  the  totality  of  the  morbid  phenomena? 
It  was,  too,  a  natural  consequence,  to  whicli  it  would  seem  that  the  most 
simple  reflexion  would  conduct  him:  but  genius  sometimes  sleeps, 
aliquando  bonus  dormitat  Homerus.  It  suffices  by  giving  a  little  attention 
to  what  passes  in  our  minds,  when  we  have  to  treat  certain  diseases,  to 
be  convinced  tliat  after  having  examined,  separately,  each  symptom,  we 
re-unite  them  all  together,  to  form  the  idea  of  a  single  disease.  For 
example,  let  an  individual  present  himself,  who  has  small  ulcers  on  the 
prepuce,  with  a  dirty  greenish  base ;  also  having  a  small  tumor  in  the 
groin,  of  an  oblong  form,  without  any  red  color,  but  hard,  and  slightly 
painful :  let  such  an  individual  recall  that  he  has  had,  fifteen  days 
before,  connection  with  a  suspected  woman.  From  all  these  circum- 
stances united,  aud  there  might  be  many  more,  I  should  form,  in  my 
mind,  an  idea  of  a  single  affection,  termed  syphilis ;  and  I  would  direct 
against  it  a  treatment  which  would  attack  all  the  symptoms  together, 
and  which,  on  that  account,  1  should  call  a7ifi-syphilitic.  I  am  ignorant 
how  a  small  quantity  of  a  salt  of  mercury  removes  all  the  accidents  of 
syphilis,  as  by  enchantment,  in  a  multitude  of  cases:  but  what  does 
this  import  ?  The  essential  for  me  and  the  patient  is,  that  I  know  that 
this  result  will  take  place,  and  under  what  conditions  it  will  be  pro- 
duced. I  know  no  more  in  regard  to  any  other  therapeutical  phenome- 
non, though  many  authors  have  given  vis,  for  three  thousand  years  past, 
very  wise  explanations  on  most  of  these  phenomena.  It  is  true  that 
nearly  all  their  explanations  have  the  inconvenience  of  differing  from 
each  other,  and  of  contradicting  themselves  even.  On  this  accoiint  it  is 
prudent  to  suspend  a  judgment,  until  the  parties  are  put  in  agreement, 
and  hold  on  to  the  crude  fact,  without  interpretations.  To  the  physicians 
who  seek  the  explanation  of  therapeutical  facts,  and  to  those  who  pre- 
tend to  have  found  them,  for  a  certain  number  of  cases,  I  will  content 


546  REFORM    PERIOD. 

myself  by  citing  the  following  words  of  Barthez :  "  Hume  has  justly  said : 
it  does  not  appear  that  any  corporeal  operation,  nor  any  action  of  the  soul 
on  its  proper  faculties  or  on  its  ideas,  can  make  us  conceive  the  production 
of  causes,  or  the  necessary  relation  which  they  sustain  to  their  ejBPects.  In 
the  succession  of  natural  phenomena,  nothing  presents  to  us  the  idea  of 
causality,  or  the  necessary  connection  between  cause  and  effect;  but 
when  the  succession  of  one  phenomenon  after  another  is  constant,  the 
human  mind  which  observes  it  assiduously,  and  which  can  frequently 
even  foresee  it,  is  led  to  believe  that  these  phenomena  succeed  each  other 
because  they  are  bound  together."" 

Thus,  then,  without  seeking  to  understand  why  mercury  removes 
venereal  accidents,  or  why  vaccine  prevents  the  variolic  infection,  why 
bark  cures  the  intermittent  fever,  etc.,  I  shall  employ  these  agents  in 
cases  where  they  are  indicated,  with  as  much  certainty  and  reason  as  I 
would  employ  blood-letting  against  an  inflammation.  I  call  the  method 
of  treatment  used  in  such  cases,  the  synthetic  method.  I  shall  not  say,  with 
a  crowd  of  theorists,  that  such  a  method  is  not  ratioi^al,  but  will  say,  on 
the  contrary,  that  it  is  very  rational,  or  rather  that  it  is,  as  the  preceding,  ' 
both  rational  and  empirical.  In  the  first  place  I  maintain  it  is  rational, 
for  the  best  reason  that  one  can  give  for  the  use  of  a  remedy  is  the  cer- 
tainty of  its  success  ;  now,  every  one  will  consent,  that  Medicine  possesses 
no  remedies  whose  efficacy  is  more  constant  than  those  which  I  have 
enumerated  above.  In  the  second  place,  the  method  is  empirical,  because 
it  is  founded  on  experience.     No  one  can  contest  this  quality. 

But  what  is  most  singular  is,  that  in  giving  to  this  method  the  epi- 
thet, empirical,  there  is  a  design  to  tarnish  it,  and  exclude  it  from  the 
class  of  means  acknowledged  by  science.  Is  it  possible  that  the  theorists 
pretend  to  banish  from  the  domains  of  art,  the  most  precious,  the  most 
efficacious,  in  a  word,  that  which  is  the  true  glory  of  the  Art  ?  When 
a  doctrine  leads  to  such  a  conclusion,  it  is  done  for ;  in  the  eyes  of  prac- 
titioners, and  of  all  men  of  good  sense,  it  is  judged  and  condemned. 

Would  to  God  that  medicine  possessed  a  greater  number  of  remedies 
called  specific,  which  are  employed  in  the  mode  of  treatment  which  we 
shall  hereafter  name  synthetic.  Then  it  would  not  be  so  often  impotent. 
But  well  established  specifics  are  very  rare,  and  on  this  account  we 
have  recourse  the  more  frequently  to  the  expectant  method,  or  to  the 
analytic  method,  the  results  of  which  are  much  less  certain.  It  too 
often  happens,  also,  that  none  of  these  methods  succeed.  Then  the 
practitioner  is  reduced  to  experimentation, — he  must  attempt  some 
exploration ;  but  in  these  cases  even,  he  does  not  go  by  chance,  but  is 

*  Preliminary  Discourse. 


THEORIES   AND   SYSTEMS.  547 

always  guided  by  certain  analogies  more  or  less  remote.  His  conduct 
does  not  then  cease  to  be  rational,  and  on  this  account  we  denominate 
this  way  of  proceeding,  the  perturhative  or  explorative  method.  This 
latter  method  is  doubtless  the  least  satisfactory  and  the  most  defective 
of  all.  The  aim  of  science  should  be  to  restrain  its  employment  more 
and  more,  and  to  enlarge,  on  the  other  hand,  the  domain  of  the  other 
methods,  and,  principally,  of  the  one  we  have  called  synthetic. 

"  Barthez,"  says  one  of  his  biographers,  "possessed,  in  a  very  high 
degree,  all  the  faculties  of  the  mind,  especially  those  which  constitute 
a  genius  for  sciences,  viz :  a  prodigious  memory,  a  vast  capacity 
for  facts,  an  inconceivable  patience  to  consider  all  their  aspects, 
the  strength  of  mind  necessary  to  seize  all  their  relations,  and  a  great 
aptitude  to  form  and  follow  the  connections  of  abstract  ideas.  He 
understood  whatever  he  studied.  His  immense  reading,  and  the  know- 
ledge which  he  had  of  numerous  languages,  had  rendered  him  familiar 
with  the  philosophers  and  wise  men  of  all  time  and  every  country. 
The  works  of  Barthez  should  have  exercised  an  influence  on  the  whole 
medical  world,  but  they  were  scarcely  felt  beyond  the  school  in  which 
he  taught.  Besides,  many  have  confined  themselves  simply  to  condemn- 
ing them,  and  sometimes,  even,  without  knowing  them."" 

If  the  influence  of  Barthez  on  the  medical  world  has  not  been  as 
general  as  might  have  boen  expected,  it  is  owing  to  some  of  the  follow- 
ing circumstances :  first,  his  system  rests,  as  we  have  shown,  on  an 
amphibological  base  :  and  nothing  is  less  proper  than  doubt,  to  excite 
the  imagination,  and  make  a  con(|ucst  of  prosel3'tes.  Secondly,  he 
affects  a  little  too  much  in  his  demonstrations,  an  abstract  form,  which 
is  not  within  the  comprehension  of  every  mind.  Thirdly,  and  lastly, 
the  epoch  of  his  greatest  renown  corresponds  with  that  of  our  revolu- 
tionary troubles, — with  the  terrible  catastrophes  that  overwhelmed 
France,  and  excited  entire  Europe, — an  epoch  most  unfavorable  for  the 
propagation  of  a  scientific  System. 


ART.    VI.    ORGANIC     DYNAMISM. 

"While  Stahl,  the  severe  logician  and  bold  reformer,  pushed  his  analy- 
sis to  the  last  limits,  and  pretended  not  only  to  determine  the  essential 
and  fundamental  function  of  life,  but  also  to  go  back  to  the  primitive 
agent  of  that  function,  which  he  affirmed  to  be  nothing  else  than  the 
rational  and  immaterial  soul,  Frederick  Hoffman,  a  less  renowned 
reasoner  and  more  timid  reformer,  confined  himself  to  seeking  what  is 

"Dezeimeris'  Diet.  Hist,  de  Medecine,  Art.  Barthez. 


548  REFORM  PERIOD. 

the  essential  and  fundamental  phenomenon  of  life,  without  explain- 
ing himself  on  its  motor  nature.  This  was,  as  is  seen,  to  simi:)lify 
the  question,  or  lower  the  problem  a  degree.  But,  reduced  to  these 
terms,  the  problem  is  still  insoluble,  as  is  proven  from  our  philosophic 
aphorisms — the  certainty  of  which  is  seen  in  the  fruitless  efforts  made 
to  that  end  up  to  this  time. 

The  latro-chemists  and  the  latro-mechanics  had  attempted  in  vain  to 
explain  the  functions  of  organized  bodies  b}"  the  general  laws  of  matter. 
Their  theories,  more  or  less  subtile  and  brilliant,  had  captivated  only  a 
part  of  the  medical  public ;  a  certain  number  of  judicious  and  attentive 
observers  had  always  rejected  them.  They  recognized  that  organized 
bodies  are  endowed  with  particular  forces  distinct  from  the  general 
forces  of  crude  matter:  from  which  they  concluded,  justly,  that  physi- 
ologists should  deduce  the  laws  of  living  or  organic  forces  from  the  direct 
observation  of  vital  phenomena,  in  the  same  manner  as  the  philosophers 
and  chemists  deduce  the  laws  of  the  general  or  inorganic  forces,  from 
the  observation  of  the  phenomena  in  crude  matter. 

The  school  of  Cos,  the  Hippocratists,  the  Animists,  the  Vitalists,  had 
already  proclaimed  this  truth  ;  but  they  had  all  supposed  the  existence  of 
a  principle,  distinct  from  the  organs,  and  giving  an  impulsion  to  the 
organism,  and  directing  its  acts  towards  an  end,  and  according  to  a  pre- 
conceived plan.  This  principle  was  called  by  some,  nature ;  by  others, 
the  soul,  or  archeus,  or  vital  principle ;  but  always  the  same  idea 
reproduced  under  different  forms. 

A  class  of  modern  physiologists  have  thought  that  we  should  consider 
the  vital  forces  as  inherent  to  the  organs,  and  study  the  action  of  these 
forces,  in  order  to  discover  their  laws,  without  engaging  in  the  considera- 
tion of  the  organizing  principle — just  as  the  philosophers  and  chemists 
regard  the  general  forces  of  crude  matter  as  inhei'ent  to  that  matter,  and 
seek  to  determine  the  laws  which  regulate  the  action  of  these  forces. 
Setting  aside  the  idea  of  the  primary  motor  force,  I  give  to  this  class 
of  physiologists  the  name  of  organo-dynamists,  to  indicate  that  they 
do  not  separate  the  active  power  or  force  (di/namis)  from  the  organ  in 
which  it  resides. 

Frederic  Hoffman  lopped  off  from  philosophy  the  ferments  and  acridities 
of  the  chemists,  the  considerations  of  the  mechanicians  on  the  contractile 
force  of  the  heart,  the  capacities  of  the  vascular  orifices,  and  the  form 
of  liquid  molecules  ;  also  the  conjectures  of  the  Animists,  toucliing  the 
essence  of  the  soul,  or  the  vital  principle.  By  all  these  retrenchments, 
his  doctrine  acquired  a  simplicity  which  is  its  principal  merit.  Besides 
it  is  presented  with  an  elegance  and  clearness  that  renders  its  perusal 
both  easy  and  agreeable.     Unhappily,  the  translation  which  I  have  been 


THEORIES   AND   SYSTEMS.  549 

obliged  to  use  is  not  marked  by  these  same  qualities,  as  may  be  seen  by 
the  following  extracts. 

"  I  will  give,"  says  this  author,  "  as  a  basis  to  my  reasoning  on  the 
whole  theory  and  practice  of  medicine,  the  definition  of  life.  Now,  this 
is  what  I  understand  by  this  word :  life  is  the  movement  of  circula- 
tion of  the  blood,  and  other  humors,  produced  by  the  systole  and  diastole 
of  the  heart  and  arteries,  or,  to  speak  more  properly,  of  all  the  vessels, 
and  all  the  fibers^  maintained  by  the  contact  of  the  blood  and  the  spirits, 
and  which,  by  means  of  the  secretions  and  excretions,  preserves  the 
body  from  all  corruption,  and  sustains  the  functions  of  every  organ. 
The  circulation  is,  indeed,  a  vital  movement,  that  preserves  the  blood 
from  putrefaction,  to  which  it  is  extremely  subject.  The  heat,  forces, 
elasticity,  firmness,  and  tension,  depend  on  it ;  and  so,  also,  the  different 
inclinations  of  men,  the  traits  and  characteristics  of  the  mind,  and  even 
wisdom  and  folly. 

"  To  guarantee,  then,  the  human  body  from  disease,  pain  and  melan- 
choly, requires  nothing  more  than  to  give  to  the  blood  the  necessary 
aid  and  succor,  and  especially  to  prescribe  a  regimen  appropriate  to  main- 
tain the  circulation  and  the  excretions  in  a  normal  state.  To  treat 
disease  is  nothing  else  than  to  cause  to  return  to  their  naturiil  condition 
the  blood  and  liquids  which  have  become  deranged. 

The  advantages  of  the  circulation  being  so  evident,  and  as  nothing 
is  able  to  move  of  itself,  is  it  not  natural  to  seek  its  cause  ?  This  research 
is  not  from  pure  curiosity,  for  he  who  knows  the  causes  of  the  circula- 
tion, can  see  much  more  easily  what  can  promote  or  retard  it,  or  what 
would  be  salutary  or  injurious  to  the  health — two  points,  the  knowledge 
of  which  constitute,  principally,  medicine. 

"After  having  seen  that  the  causes  of  the  circulation  are  the  con- 
traction and  dilatation  of  the  solid  parts  of  the  body,  and  that  all  the 
movements  of  the  fluids  depend  on  these,  we  can  not  avoid  going  back 
to  the  study  of  the  causes  of  this  contraction  and  dilatation.  Xow,  I 
can  see  none  other  than  the  blood  ;  for  it  is  not  only  composed  of  solid 
and  humid  principles,  but  also  of  a  sulphurous  matter,  susceptible  of 
a  very  active  movement,  of  air,  and  of  the  ethereal  matter,  which  is 
secreted  in  part  in  the  brain,  with  an  extremely  tenuous  lymph,  which 
serves  it  as  a  vehicle. 

"  Let  us  examine,  now,  how  the  concourse  of  the  blood,  and  the 
nervous  juice,  in  the  organic  parts,  produce  in  them  the  vital  movement 
of  contraction  and  dilatation.  All  the  fibers  of  which  the  organic 
parts  are  composed  have  naturally  very  much  elasticity,  and  being 
stretched  by  the  influx  of  the  liquors,  not  only  contract  and  relax, 
but  even  return  from  a  point  of  too  great  contraction  to  their  natural 


550  REFORM   PERIOD. 

state.  The  diastole  is,  then,  always  the  cause  of  the  systole,  and  vice 
versa.  Thus,  the  machinery  of  the  heart  is  the  perpetual  motion, 
sought  unsuccessfully  for  a  long  time  ;  for  the  blood  excites  the  heart, 
which  gives  motion  to  the  blood,  and  by  this  mechanism  the  cause 
produces  an  effect,  from  which  arises  the  reproduction  of  the  cause 
itself."  * 

This  physiological  theory  is,  as  I  have  said,  one  of  the  most  simple, 
but  it  must  be  seen,  also,  that  it  is  not  remarkable  for  strength  of 
reason.  I  shall  not  attempt  to  uncover,  in  detail,  the  errors  that  it 
includes ;  I  will  only  call  the  attention  of  the  reader  to  the  final  pro- 
position, which  is  the  top  stone  of  the  whole  doctrine :  the  blood  excites 
the  heart,  which  in  its  turn  gives  motion  to  the  blood ;  and  behold, 
exclaims  the  author,  with  artless  admiration,  the  perpetual  motion 
found  !  But  the  reader  has  easily  seen  that  the  explanations  of  Hoff- 
man turn  in  a  vicious  circle,  and  that,  in  short,  they  explain  nothing. 

Let  us  see,  now,  some  practical  consequences  of  this  theory  :  "  Dis- 
eases of  every  species  being  only  a  union  of  the  natural  movements^ 
may  then,  as  all  the  vital  movements,  be  associated  in  two  classes :  the 
systole  and  diastole  ;  in  other  words,  contraction  and  dilatation  ;  for  if 
the  contraction  is  too  strong,  or  too  long,  it  is  called  spasm ;  if  the  dila- 
tation err  in  excess  or  duration,  it  is  called  atony.  Now,  what  serious 
trouble  do  both  these  defects  produce  in  the  circulation  !  In  one,  its 
equality  is  broken,  in  the  other  its  free  course  is  greatly  interrupted.! 

"  Since  the  movements  can  err  only  by  augmentation  or  diminution, 
we  must  conclude,  from  this,  that  there  is  only  need  of  two  classes  of 
remedies,  namely :  one  capable  of  calming  the  convulsive  movements, 
called  in  the  schools,  sedative  and  anti-spasmodic  remedies ;  the  other, 
called  confortatives  or  tonics,  which  are  appropriate  to  give  to  the  flabby 
and  relaxed  parts  their  natural  tension.  "| 

Thus  the  illustrious  Dean  of  the  University  of  Halle  leads  us,  by  a 
circuit,  to  the  pathological  and  therapeutical  dichotomy  of  the  ancient 
Methodists ;  a  dichotomy  which  considered  diseases  and  remedies  from 
two  points  of  view  only,  and  is  entirely  insufficient  in  the  practice  of 
the  Art,  since  it  rests  on  a  hypothesis  contrary  to  observation  ;  that  is 
to  say,  that  there  are  only  two  sorts  of  modifications  in  the  animal 
economy. 

The  argument  of  Hoffman  is  weak,  and  lacks  depth  ;  it  is  very  super- 
ficial, and  never  carries  a  principle  to  its  extreme  censequences,  which 
denotes  a  mind  more  observing  than  logical.     This  judgment,  which  we 

*  Medecine  Raisonnee  d'Hoffman,  translated  by  Bruhier.     Paris,  1739. 
J  Ibid.  '        I  Ibid. 


II 


THEORIES   AND    SYSTEMS.  551 

should  form  a  j^^iori,  in  reading  the  "  Eational  Medicine  "  of  this 
author,  is  confirmed  by  his  biographers.  Hoffman,  they  say,  enjoyed 
during  his  life  the  reputation  of  the  greatest  physician  in  Europe. 
Boerhaave  himself  seems  to  have  rendered  him  this  testimony  on  a 
memorable  occasion.  Having  been  consulted  by  the  king  of  Prussia, 
William  I.,  he  replied  to  that  sovereign  that  the  best  counsel  that  he 
could  give  him  was,  to  apply  to  Hoff"man. 

A  practitioner  so  eminent  should  have  made  theory  subordinate  to 
practice ;  that  is  to  say,  estimate  the  first  only  in  regard  to  the  services 
it  could  render  the  second,  and  judge  of  the  truth  of  a  doctrine  by  its 
accordance  with  pathological  and  therapeutical  facts.  Such  is,  indeed, 
the  rule  that  F.  Hoffman  establishes  to  appreciate  the  value  of  a  med- 
ical doctrine.  "  The  character,"  he  says,  "  of  a  true  and  solid  theory 
in  Medicine  consists  in  its  appositeness  to  the  practice,  or,  in  other 
words,  in  its  ability  to  explain  all  the  circumstances  in  the  histories  of 
diseases,  in  the  succession  in  which  they  have  appeared,  and  to  draw 
from  them  useful  conse<|uences  in  the  practice,  in  order  to  give  rational 
and  advantageous  counsels." 

But  none  of  the  theories  professed  in  his  time  could  fill  these  condi- 
tions in  a  complete  and  absolute  manner,  and  he  could  do  nothing  bet- 
ter than  to  take,  in  each  one  of  them,  what  appeared  to  him  to  be  the 
most  useful  and  rational,  without  being  able  to  account  perfectly  for  the 
motives  of  these  determinations,  and  justify  them  by  a  solid  argument, 
acting,  in  that  respect,  like  those  whose  choice  would  result  from  instinct 
rather  than  reason ;  in  a  word,  he  was  eclectic,  as  he  also  declares  him- 
self in  his  eulogy  of  that  ambiguous  doctrine.  Still,  he  inclines  to 
Solidism,  which  he  had  freed  from  the  calculations  with  which  the  iatro- 
raechanics  had  loaded  it.  "We  must  admire,"  he  says,  "a  physician 
free  from  all  bondage  to  all  sects  or  hypotheses,  who  puts  everything  in 
the  balance,  and  adopts  only  what  is  conformable  to  reason  and  experi- 
ence, and  rejects,  carefully,  that  which  is  opinion  only."  Very  well ! 
nothing  is  better  than  to  adopt  for  guides,  reason  and  experience ;  but 
the  difficulty  is,  never  to  be  separated  from  either.  Now,  up  to  this 
time,  none  of  the  medical  theories  that  we  have  announced,  without  even 
excepting  that  of  Hoffman,  has  resisted  the  test  of  this  double  light. 

Perhaps  we  shall  be  more  successful  in  the  future ;  possibly  we  shall 
encounter,  at  last,  a  physiological  doctrine  which  will  account  perfectly 
for  the  phenomena  of  the  animal  economy,  both  in  a  pathological  and 
normal  state.  AVe  proceed  now  to  enter  into  an  order  of  new  ideas,  of 
which  antiquity  offers  us  no  model,  and  to  which  the  theory  which  we 
have  just  studied  serves  in  some  sort  for  an  introduction.  Up  to  this 
time,  no  one  had  considered  the  movements  of  the  organized  solids  but 


552  REFORM    PERIOD. 

as  the  cflFect  of  elasticity.  Hoffman  himself  represents  them  to  us  in 
no  other  manner,  in  the  passages  which  we  lately  quoted.  But  when 
the  great  Haller  had  demonstrated,  by  a  series  of  experiments,  that  the 
contractility  of  muscular  fibers,  and  other  tissues,  is  a  special  property 
of  living  solids,  essentially  distinct  from  elasticity — from  that  moment, 
it  began  to  be  suspected  that  this  property  recently  discovered,  which 
was  named  irritability,  might  well  be  considered  as  the  characteristic 
sign  of  organization,  the  source  of  all  the  phenomena  of  life. 

Cullen,  author  of  a  very  remarkable  nosological  classification,  of 
which  we  have  already  spoken,  attempted  the  first  to  establish  a  medical 
doctrine  on  the  development  of  the  phenomena  of  irritability.  Pos- 
sessed of  a  cool  and  observing  mind,  he  comprehended,  in  the  onset, 
that  if  he  would  assume  this  property  as  the  base  of  the  functions 
of  the  animal  economy,  he  must  not  push  his  researches  farther,  but 
admit  it  as  a  primitive  fact,  whose  causes  escape  our  investigations ; 
else  he  might  fall  into  the  vicious  circle  into  which  Hoffman  and  so  many 
others  had  been  drawn,  who,  after  having  taken  the  circulation  of  the 
blood,  or  any  other  phenomenon,  as  a  starting  point,  were  obliged  after- 
ward, to  make  this  primordial  phenomenon  depend  upon  some  other  func- 
tion. Nevertheless,  he  could  not  avoid  these  contradictions  ;  for  when 
we  have  adopted  a  false  principle,  it  is  impossible  for  us  to  escape  the 
consequences  that  flow  naturally  from  it.  We  are  thus  drawn  from 
deduction  into  deduction,  in  spite  of  ourselves,  by  a  current  stronger 
than  our  will. 

Cullen  may  tell  us  as  much  as  he  pleases,  that  irritability,  being  a 
primitive  fact,  there  is  no  necessity  for  seeking  its  cause  ;  nevertheless, 
an  instant  after,  he  violates,  himself,  this  injunction,  in  affirming  that 
irritability  is  aroused  and  put  in  play  by  an  extremely  subtile  fluid 
which  the  brain  secretes,  and  which  is  distributed  everywhere  by  the 
nerves.  If  you,  then,  demand  whence  comes  this  nervous  fluid,  this 
physiologist  will  respond  that  it  originates  in  the  most  subtile  portions 
of  the  blood  and  lymph,  which  are  carried  to  the  brain  by  means  of  the 
contraction  of  the  heart  and  arteries.  In  short,  according  to  this  system 
the  irritability  of  the  heart  is  sustained  by  the  nervous  fluid,  which  fluid 
is  itself  a  consequence  of  the  irritability  of  the  heart.  Eeaching  this 
result,  and  perceiving  that  he  had  fallen  into  a  vicious  circle,  which 
he  had  hoped  to  avoid,  Cullen  ends  by  avowing,  as  all  the  great  physi- 
ologists before  him  had  done,  that  the  phenomena  of  life  forming  a 
circle,  it  was  a  matter  of  no  importance  where  we  begin  or  end  in  their 
study.  It  is  not,  therefore,  to  be  wondered  at,  that  sometimes  the  cir- 
culation of  the  blood  was  supposed  to  be  the  principle  on  which  depended 
all  the  functions  of  the  animal  economy ;    and  again,  that  the  nervous 


i 


THEORIES  AND  SYSTEMS.  553 

system  is  the  most  important  of  all  the  organic  aparatus — the  one  that 
first  feels  the  impression  of  excitants,  and  transmits  it  to  others  ;  in 
a  word,  that  gives  impulsion  to  all  the  movements  of  the  organism. 
"  We  adopt,"  he  says,  at  the  commencement  of  his  "  Treatise  on  Materia 
Medica."  "  this  maxim:  Remedies  do  not  act  upon  a  dead  body,  because 
their  action  depends  neither  on  the  laws  of  matter  nor  those  of  motion, 
but  on  the  principles  of  life.  •  These  are,  then,  the  principles  which 
should  be  the  object  of  our  researches,  and  they  form  a  circle  in  such  a 
way  as  to  leave  us  in  uncertainty  as  to  what  point  we  should  commence 
or  end.  The  circulation  of  the  blood  appears  to  be,  nevertheless,  the 
principle  of  vitality  on  which  all  others  depend."  Cullen  did  not  take 
the  trouble  to  prove  in  what  the  circulation  of  the  blood  appeared  to 
him  to  have  priority  over  the  other  principles  of  life ;  he  contented  him- 
self with  recalling  the  opinions  of  Boerhaave  on  that  subject.  How- 
ever, we  shall  find  him,  further  on,  giving  the  priority  to  the  nervous 
system. 

Let  us  leave,  for  the  present,  this  discussion  of  general  principles, 
and  pass  to  the  application  which  the  author  makes  of  them  to  pathology 
and  therapeutics.  He  commences  by  declaring  that  the  autocracy  of 
nature,  adopted  under  whatever  form,  by  different  sects,  has  been  preju- 
dicial to  the  practice  of  many  physicians,  from  Hippocrates  down  to 
Stahl.  He  avows  himself,  also,  the  adversary  of  the  empirical  method, 
and  of  all  specific  remed'es,  the  number  of  which  he  thinks  every  one 
ought  to  diminish  as  much  as  possible.  "I  would  go,"  he  says,  "  much 
further,  and  show  how  much  the  autocracy  of  nature,  adopted  under 
whatever  form  by  the  different  sects,  has  been  prejudicial  to  the  practice 
of  all  physicians,  from  Hippocrates  to  Stahl."  In  his  Institutes  of 
Medicine  he  proscribes,  rigorously,  the  employment  of  specifics  ;  how- 
ever, he  is  forced  to  admit  them  in  his  treatise  on  materia  medica,  and 
makes  the  following  avowal,  which  is  worthy  of  being  transcribed : 
"  I  have  testified  elsewhere  my  repugnance  for  specific  medicines ; 
but  we  shall,  perhaps,  be  forced  to  retain  many  of  them  still,  though  we 
should  make  efi"ort3  to  diminish  their  number  as  much  as  possible." 

Thus  Cullen  repelled  the  expectant  method,  the  only  one  that  we  could 
or  should  employ  on  many  occasions,  and  the  synthetical  method, 
vulgarly  named  the  empii'ical,  the  most  efficacious  of  all.  He  declares 
that  the  cure  of  diseases  should  be  particularly  and  nearly  unirpely 
founded  on  the  knowledge  of  their  proximate  causes,  or,  in  other  words, 
he  rejects  all  methods  of  treatment  as  irrational,  except  the  analytic — a 
method  often  defective,  but  which  seduces  us  by  an  illusory  appearance 
of  profundity.  Besides,  this  author  makes  use  of  analysis  with  admir- 
able sagacity,  whether  he  attempts  to  explain  the  generation  of  morbid 
35 


554  REFORM   PERIOD. 

phenomena,  or  to  justify  the  employment  of  remedies.  The  following 
are  examples  of  the  application  of  this  method  to  two  of  the  most 
important  and  difficult  cases  in  pathology : 

I.  "  Our  doctrine  of  fevers,"  says  Cullen,  "  is  reduced  to  the  fol- 
lowing principles  :  The  remote  causes  are  certain  sedative  influences  act- 
ing on  the  nervous  system,  which,  diminishing  the  energy  of  the  brain, 
produce,  necessarily,  debility  in  all  the  functions,  and  particularly  those 
of  the  minute  vessels  of  the  surface.  Nevertheless,  such  is  at  the  same 
time  the  nature  of  the  animal  economy,  that  this  debility  or  atony  (the 
proximate  cause  of  the  fever)  becomes  an  indirect  stimulant  to  the  vas- 
cular system.  This  stimulant,  aided  by  the  accession  of  the  chill  and  of 
the  spasm  which  accompanies  it,  augments  the  action  of  the  heart  and 
great  arteries,  and  continues  thus  until  it  is  able  to  re-establish  the  energy 
of  the  brain,  and  communicate  this  energy  to  the  small  vessels,  and 
re-animate  their  action,  and  especially,  by  this  means,  destroy  their 
spasms.  The  latter  being  relieved,  the  sweat,  and  all  the  other  signs  of 
relaxation  of  the  excretory  conduits,  take  place." 

II.  "  All  the  phenomena  of  inflammation  concur  to  prove  that  the 
impetuosity  of  the  circulation  of  the  blood  is  accelerated  in  the  afi"ected 
part ;  but,  in  this  case,  the  action  of  the  heart  is  not  always  augmented ; 
we  may  therefore,  presume  that  the  acceleration  of  the  circulation  of  the 
blood  in  the  affected  part  is  due  especially  to  the  augmented  action 
of  the  vessels  of  the  affected  part  itself.  '•'  "  =••■=  The  spasm 
of  the  extremities  of  the  arteries  that  sustain  the  increased  action  of 
the  blood,  which  is  pushed  into  them,  must  then  be  regarded  as  the 
proximate  cause  of  inflammation,  at  least  in  all  cases  where  the  inflam- 
mation is  not  produced  by  the  direct  action  of  stimulants,  and  even 
under  such  circumstances  we  may  suppose  that  these  occasion  a  spasm 
in  the  extremities  of  the  vessels." 

I  have  no  need  to  remark  how  much  this  doctrine  agrees  with  that  of 
f .  Hoffman  ;  in  one,  as  in  the  other,  only  two  general  causes  of  diseases 
are  admitted :  spasm,  or  the  augmentation  of  tension,  and  atony,  or 
relaxation.  Only  the  Scotch  pathologist  places  the  point  of  departure 
of  morbid  phenomena  in  the  nervous  fibrillae,  which  are  always  supposed 
to  receive  the  first  impressions  of  morbific  agents,  and  communicate 
them  at  once  to  the  last  arterial  ramifications,  while  the  German  pathol- 
ogist considers  the  excessive  afflux  of  the  blood  as  the  first  motor  of 
abnormal  movements  in  the  parts,  as  the  primitive  cause  of  the  alter- 
nate tension  and  relaxation  of  the  fibers. 

Cullen,  like  Hoffman,  was  a  circumspect  practitioner  and  skillful 
observer,  rather  than  a  profound  dialectician.  He  did  not  hesitate  to 
abandon    his    theory    whenever    it    appeared    to    disagree   with    his 


f 


1 


THEORIES   AND   SYSTEMS.  565 

experience.  So,  notwithstanding  his  repugnance  for  specifics,  he  readily 
admitted  a  goodly  number  into  his  Materia  Medica ;  and  notwithstand- 
ing his  inclination  for  Solidism,  he  admits  remedies  which  are  supposed 
to  act  on  the  humors,  such  as  alternants,  anti-acids,  anti-alkalies,  etc. 
We  do  not  bring  against  him  any  reproach  for  this ;  we  praise  him,  on  the 
contrary,  for  having  stated,  in  many  cases  with  great  precision,  the  cura- 
tive indications  from  the  apparent  phenomena  of  the  diseases,  without 
stopping  to  inquire  whether  they  conformed  or  not  to  his  theoretical 
explanations.  In  continued  fevers,  for  example,  he  recognizes  threejgen- 
eral  indications  to  be  fulfilled :  First,  to  moderate  the  violence  of  the  reac- 
tion ;  second,  to  remove  the  causes,  and  prevent  the  cff"ects  of  debility ; 
third,  to  arrest  or  correct  the  tendency  of  the  fiuids  to  putrefaction. 
In  intermittents,  he  points  out  three  curative  indications  :  First,  during 
the  period  of  intermission,  to  provide  against  the  return  of  the  parox- 
isms ;  second,  during  the  paroxisms  to  take  such  steps  as  would  procure 
a  perfect  crisis  of  the  disease  ;  third,  to  remove  obstacles  which  might 
might  prevent  the  fulfillment  of  the  first  two  indications.  If  we  consult 
the  most  recent  treatises  of  Medicine,  we  shall  see  that  the  curative 
indications  laid  down  in  them  are  almost  the  same  for  these  same 
classes  of  diseases ;  so  that  in  regard  to  therapeutics,  the  general  views 
have  changed  but  little  since  Cullen.  Besides,  to  carry  out  these  views. 
he  employed  nearly  the  same  means  as  ourselves,  though  his  manner  of 
studying  diseases  and  the  action  of  remedies  was  very  difierent  from 
ours ;  which  proves  that  the  greater  part  of  the  rules  of  practice  are 
founded  on  pure  observation,  and  independent  of  all  theoretical  inter- 
pretation, or  comply  equally  with  a  variety  of  difi^erent  interpreta- 
tions. This  is  a  consoling  fact  that  history  alone  could  make  evident, 
and  Avhich  justifies  in  our  eyes  the  practice  of  past  ages,  notwithstand- 
ing the  incessant  variations  of  theories,  as  it  will  justify  in  the  eyes  of 
our  successors,  our  present  practice.  Cullen  had  the  pain  to  see  spring 
up  at  his  side,  in  his  own  home,  a  doctrine  which,  though  hardly  hatched, 
became  a  menacing  rival  of  his  own. 

John  Brown,  born  of  obscure  parents  in  a  village  of  Berwick,  in  Scot- 
land, was  remarkable,  from  his  early  youth,  for  an  extraordinary  apti- 
tude for  acquiring  languages,  a  decided  inclination  for  scholastic  dispute, 
a  pedantic  tone  and  manner,  and  somewhat  irregular  conduct.  Having 
abandoned  theology  for  medicine,  he  fixed  his  residence  in  Edinburgh, 
where  he  assiduously  followed  the  lectures  of  the  professors.  He  after- 
wards repeated  and  explained  them  to  other  students  for  a  compensa- 
tion. He  also  translated  into  Latin  the  theses  of  those  who  were  not 
sufficiently  familiar  with  the  language,  and  wrote  in  it  on  every  subject, 
for  those  who  preferred  paying  for  such  labor,  rather  than  perform  it 


1 


556  REFORM    PERIOD. 

themselves.  He  was  particularly  entertained  and  countenanced  Ly  Cul- 
len,  who  even  took  him  into  his  family  in  the  character  of  preceptor  of  his 
children.  This  agreeable  relation  subsisted  during  twelve  consecutive 
years  between  these  two  men,  whose  characters  and  minds  were  so  differ- 
ent. The  protege  was  grateful  for  the  countenance  of  his  preceptor, 
aided  him  in  his  labors,  and  unceasingly  praised  him.  But  some  tri- 
fling matters  of  mutual  discontent  grew  at  length  into  coldness, 
and  changed  the  old  friendship  which  had  united  them  into  an  irrecon- 
cilable hatred. 

Their  rupture  broke  out  about  the  year  1778,  and  in  a  short  time 
after,  Brown  published  his  Elements  of  Medicine.  The  eulogies  which 
he  received  on  that  occasion,  and  the  encouragement  of  some  friends, 
determined  him  to  make  this  work  the  foundation  of  a  public  course  of 
lectures,  in  which  he  gave  his  theory  every  possible  development. 
Then  commenced  between  the  master  and  the  pupil  an  obstinate  conflict, 
which  agitated  the  University  of  Edinburgh  for  several  years  ;  a  con- 
flict but  little  interesting  to  posterity,  on  account  of  the  personal  vanity 
and  interests,  which  are  much  more  conspicuous  there  than  its  scientific 
interest.  Brown,  whose  pride,  inflated  by  partial  success,  made  him 
indifferent  to  every  one — whose  impassioned  eloquence  overwhelmed 
with  satiric  strokes  whoever  shared  not  his  opinions,  was  in  the  end 
alienated  from  the  whole  Faculty,  who  endeavored,  henceforth,  to  inter- 
fere with  his  teaching,  In  vain,  though  sustained  by  the  zeal  of  some 
enthusiastic  partisans,  and  by  his  natural  pride,  he  essayed  to  make 
head  against  the  storm  ;  he  was  compelled  to  give  way  before  the  con- 
tinual increase  of  his  enemies.  In  1786  he  put  in  execution  the  project 
which  he  had  meditated  for  some  time,  of  going  to  exhibit  himself  in  a 
greater  theater.  He  embarked  for  London,  where  he  died  in  1788,  aged 
fifty-two  years,  a  victim  to  his  intemperance  and  medical  delusions. 

Brown  employed  some  of  the  ideas  of  his  master  to  develop  a  doc- 
trine much  more  simple  in  appearance,  but  founded  entirely  on  abstract 
considerations ;  a  doctrine  in  which  every  provision  seems  to  be  made 
for  discussion,  but  none  for  practice.  Cullen  had  said  that  the  nervous 
system  receives  the  first  impression  of  excitants,  and  transmits  it  after- 
wards to  the  other  organs  endowed  with  motion  and  vitality.  Brown 
explains  thus,  the  same  thought :  "  Life  is  only  sustained  by  incita- 
tion.  It  is  only  the  result  of  the  action  of  incitants  on  the  incitability 
of  organs."  =■'  Cullen  regarded  the  atony  of  the  small  vessels  as  the 
proximate  cause  of  fever.  Brown,  improving  on  this  hypothesis,  admits, 
with  hardly  any  exceptions,  only  hyposthenic  diseases.     These  are  the 

■'  Elements  of  Medicine,  Part  I,  cliap.  ii. 


THEORIES   AND   SYSTEMS.  557 

only  relations  that  exist  between  tliese  congenerous  doctrines.  On  all 
other  points  they  dilBFer,  or  are  in  opposition.  One  is  the  work  of  a 
skillful  practitioner,  who  departs  as  little  as  possible  from  observation, 
or  who  hastens  to  return  when  his  arguments  have  carried  him  away 
from  it — loving  much  better  to  renounce,  for  the  moment,  his  theory, 
than  the  testimony  of  his  senses.  The  other  is  the  conception  of  a 
mind  essentially  logical,  and  possessing  a  strong  imagination,  but  of  an 
observer  preoccupied  or  distracted,  who  sees  objects  only  through  the 
prism  of  his  ideas, 

'■We  do  not  know,"  says  Brown,  "  what  incitability  is,  nor  how  it  is 
affected  by  inciting  agencies;  but  whatever  it  may  be,  every  being  which 
begins  to  live,  is  provided  with  it  to  a  certain  degree.  Our  ignorance 
on  the  nature  of  this  faculty,  the  poverty  of  ordinary  language,  and  the 
novelty  of  the  doctrine,  obliges  me  to  employ  peculiar  expressions.  1 
will  say,  that  commonly,  incitability  abounds,  when  we  apply  a  slight 
stimulus ;  that  at  other  times  it  fails — is  crushed  or  consumed,  when 
the  stimulus  is  too  violent.  Here,  as  elsewhere,  we  must  hold  to  the 
truth.  Avoid  carefully,  since  the}-  are  nearly  incomprehensible,  the  dan- 
gerous question  of  causes,  that  venomous  serpent  of  philosophy.  Let 
no  one,  then,  believe,  from  what  I  have  just  said  in  regard  to  the 
nature  of  incitability,  that  I  pretend  to  decide,  if  it  is  a  substance,  and 
therefore  sometimes  augments  and  again  diminishes,  or  if  it  is  a  faculty 
inherent  in  matter  which  is  sometimes  excited  and  again  languishes  ; 
nor  that  I  wish  to  resolve  in  any  manner  a  question  so  abstract.  These 
researches  have  nearly  always  done  much  injury  to  science." 

Brown  employs  here  the  same  artifice  as  Barthez.  To  evade  the 
objections  that  might  be  brought  against  it,  if  he  should  affirm  that 
incitability  is  a  substance,  or  if  he  affirmed  that  it  is  a  faculty  inherent 
only  to  the  organs,  he  shelters  himself  behind  the  doubt.  By  this  arti- 
fice, he  reserves  to  himself  the  advantage  of  being  able  to  consider  this 
equivocal  being,  sometimes,  as  distinct  from  all  parts  of  the  body,  hav- 
ing its  own  proper  existence,  and  again,  as  united  to  the  organs  in  an 
inseparable  manner.  But  the  doubt  of  Brown  is  only  the  ruse  of  the 
sophist.  In  every  other  part  of  his  work  we  do  not  find  the  least  appear- 
ance of  skepticism;  everywhere  its  tone  is  dogmatic  and  affirmative. 
The  author  considers  so  well  incitability  as  a  being  distinct  from  the 
organism,  that  he  even  goes  so  far  as  to  attribute  to  it  the  formation  of 
the  organs.  "  The  first  cause,"  he  says,  "  of  the  formation  of  the  sol- 
ids, and  the  sole  means  of  their  subsequent  sustenance  is  incitatiou."" 

This  is  rapid  progress  in  a  little  time.  This  timorous  philosopher, 
who  dared  advance  nothing  touching  the  nature  of  incitability,  who 
would  banish  from  his  doctrine  the  venomous  serpent  of  causes,  does  not 


558  REFORM   PERIOD. 

hesitate  now  to  say,  that  incitability  is  the  first  cause  of  the  formation 
of  solids,  that  it  is  what  creates  and  what  determines  the  state  of  the 
simple  solids  and  the  humors.  The  skepticism  which  he  afi'ected  at  the 
commencement  is  but  an  oratorical  artifice,  made  use  of  to  introduce  his 
physiological  principles  without  discussion.  In  fact,  this  principle 
could  not  resist  a  serious  examination,  for  in  the  onset,  an  impassable 
objection  could  be  made  to  it,  for  it  might  be  said:  If  the  first  cause  of 
the  formation  of  the  solids  is  incitation,  on  what  does  it  exercise  itself 
anterior  to  their  existence  ?  There  is  no  response  possible  to  such  a 
question,  in  Brown's  entirely  Solidist  system. 

Now,  as  we  have  shown  the  weakness  and  nothingness  of  the  basis 
on  which  this  whole  system  rests,  let  us  follow  a  little  its  developement. 
The  Scotch  physiologist  distinguished  only  two  pathological  states — one 
consisting  in  an  excess  of  incitability,  which  he  names  the  sthenic  dia- 
thesis ;  the  other,  constituted  by  a  want,  more  or  less  notable,  of  the 
the  same  faculty,  which  he  designates  as  the  asthenic  diathesis. 
Besides,  Brown  considers  these  two  state  as  affecting  the  entire  economy, 
rather  than  any  organ  in  particular.  A  local  affection  rarely  appears 
to  him  to  be  worthy  the  attention  of  a  practitioner :  he  gives  but  little 
attention  except  to  the  general  state  of  the  body,  sustaining  this  method  of 
the  study  of  disease  by  a  singular  calculation, 

"  Let  the  principal  affection,"  he  says  "  be  as  six,  and  the  minor 
one  of  each  part  as  three :  the  number  of  parts  but  slightly  affected 
as  one  thousand ;  the  partial  affection  will  be  to  the  general  affection 
of  the  rest  of  the  body,  in  the  ratio  of  six  to  three  thousand." 
He  concludes  from  this,  that  in  general  disease,  each  local  affection, 
however  redoubtable  it  may  be  otherwise,  must  be  considered  as  a  part 
of  the  first,  and  therefore  the  remedies  must  l)e  directed,  not  to  the  part 
chiefly  affected,  but  to  the  whole  organism.  This  strange  calculation  is 
not  the  result  of  observation — it  had  no  foundation  but  in  his  imagina- 
tion, and  is  in  flagrant  contradiction  to  the  results  of  daily  observation. 
After  having  reduced  all  diseases  to  two  genera,  and  withdrawn  from 
pathology  the  study  of  local  lesions.  Brown  arrives,  by  a  subtile  argu- 
mentation, to  consider  the  affections  of  the  sthenic  order  as  prevailing 
in  a  very  small  number  of  instances,  so  that  the  diseases  of  the  asthenic 
type  comprehend  nearly  the  totality  of  affections.  According  to  this 
theory,  a  physician  is  rarely  ever  mistaken  if  he  orders,  in  all  his  cases, 
remedies  of  an  exciting  nature.  When  I  say  always,  I  exaggerate,  for 
he  would  err  three  times  in  a  hundred,  which  is  sufficiently  accurate  in 
medical  practice."  '■■' 

**  The  following  explanation  is  thus  given  by  one  of  the  fervent  expounders  of 
the  Brunonian  doctrine  :    "  However  this  may  be,  as  in  general,  the  diseases  in 


THEORIES  AND  SYSTEMS.  559 

Never  since  the  days  of  Thessalus  (of  charlatan  memory)  had  any 
one  simplified  to  such  a  point  the  study  and  practice  of  medicine. 
We  may  even  say  that  in  this  respect  the  Scotch  pathologist  left  far  in 
the  rear  the  physician  of  Nero.  To  this  attraction,  well  calculated  to 
tempt  students  and  practitioners,  the  doctrine  of  Brown  joined  the 
advantage  of  beiii-^  presented  in  an  energetic  and  captivating  style,  full 
of  imagery,  which  suffices  to  explain  its  rapid  progress.  But  this  doc- 
trine, so  seductive  in  its  exposition,  so  easy  in  its  application,  is  one  of 
the  most  disastrous  that  man  has  been  able  to  imagine,  for  it  tends  to 
propagate  the  abuse  of  diffusible  stimulants,  of  which  spirituous  liquors 
make  a  part,  an  abuse  excessively  injurious  to  health  in  general,  and  the 
intellectual  faculties  in  particular — an  abuse  to  which  man  is  too  much 
inclined,  naturally,  and  which  the  sophisms  of  Brown  may  have  contrib- 
uted to  spread  in  all  classes  of  English  society." 

One  is  frightened  in  reading  the  long  list  of  diseases  against  which 
the  Scotch  pathologist  does  not  hesitate  to  prescribe  the  most  energetic 
stimulants.  Here  is  a  sample  of  this  list,  extracted  from  the  table 
of  Linch :  plague,  confluent  variola,  apoplexy,  paralysis,  gangrenous 
angina,  synocha.  typhus,  hydrothorax,  phthisis,  dysentery,  etc.;  such 
are  the  affections  which  this  bold  theorist  advises  to  be  treated  by 
electricity,  opium,  ether,  spirit  of  wine,  and  other  stimulants  of  this 
nature,  to  be  employed  in  increasing  doses,  in  proportion  as  the  diseases 
progress.  "  No  other  systematic  author,"  says  M.  Cotanceau,  "  has 
less  known  the  totality  and  the  details  of  medicine,  and  one  has  reason 
to  be  astonished,  on  each  page  of  his  book,  at  the  imperturbable  assur- 
ance with  which  he  accommodates  the  particular  facts  of  pathology  to 
the  consequences  of  his  theory.  As  a  nosographer,  he  is  below  all ;  and 
I  know  no  treatise  on  popular  medicine,  that  does  not  include  a  history 
of  diseases  very  superior  to  his.  Though  he  continually  pleads,  as  is 
usual,  the  increased  number  of  facts  in  favor  of  his  doctrine,  we  recog- 
nize every  moment  the  absolute  want  of  observation,  and  the  most 
superficial  judgment.  Neither  is  there  anything  in  his  work  to  lead 
you  to  suppose  that  he  has  studied  authors  any  more  than  nature ;  or 
if  he  has  read  any,  it  was  without  meditating  upon  them,  for  he  never 
quotes  any,  scarcely,  nor  combats  any  theory — he  believes  that  he  has 
extinguished  all  by  the  exposition  of  his  own.     He  advises  his  students, 

which  stimulants  are  useful,  are,  from  the  number  of  those  that  require  evacua- 
tions, in  the  proportion  of  ninety-seven  to  three.  It  is  very  probable  that  the 
alexipharmic  was  universally  more  useful  than  the  antiphlogistic  or  evacuant 
method."  Nouvelle  Doctrine  de  Brown,  translated  from  the  Italian  bj'  Lafont 
Gonzi,  introduction,  p.  125.     Paris,  1807. 

'  Journal  Hebdomadaire  de  Med.,  27  Feb.,  1830. 


560  REFORM    PERIOD. 

nevertheless,  to  learn  what  is  necessary  in  anatomy,  to  open  dead  bodies, 
and  study  the  illustrious  Morgagni.  If  he  had  done  this  himself  he 
would  have  seen  himself  refuted  on  every  page."  ••■^ 

Notwithstanding  its  defects,  the  system  of  Brown  made  rapid  pro- 
gress, principally  in  Grermany  and  Italy  ;  but  it  is  not  difficult  to 
understand  this  success,  when  we  think  that  this  system  favored, 
remarkably,  the  indolence  of  physicians,  in  reducing  the  science  and 
the  art  to  an  extreme  simplicity,  and  which  was  not  less  agreeable  to 
the  patient,  as  it  countenanced  intemperance.  Joined  to  this,  the 
attraction  of  novelty,  the  charms  of  a  passionate  language  which 
indicates  conviction,  and  you  will  comprehend  that  nothing  more  was 
needed,  or  even  as  much,  to  obtain  numerous  and  enthusiastic  proselytes. 
In  Italy,  Brunonism  was  soon  modified  in  an  important  manner,  which 
changed  entirely  its  economy.  Rasori,  while  admitting  two  orders  of 
diseases,  founded  on  the  excess  or  want  of  incitation,  reversed  their 
numerical  proportions.  According  to  him,  the  asthenic  affisctions  arc 
rare,  and  the  sthenic  much  more  common.  According  to  Brown,  we  must 
stimulate  unceasingly,  but  with  liasori  contra-stimulants  were  much 
more  frequently  used,  viz  :  antiphlogistics  and  sedatives.  Moreover, 
the  Italian  school  did  not  judge  the  value  of  remedies  from  pure 
theoretical  considerations,  but  from  experiments,  undertaken  with  the 
view  to  determine  their  value. 

Brunonism  did  not  find  as  easy  access  into  France,  which  was 
doubtless  owing  to  the  anatomical  dii'ection  of  studies  in  the  school  at 
Paris,  and  the  influence  of  the  Vitalism  of  Barthez  in  the  school  at 
Montpellier.  Nevertheless,  it  had  commenced  a  progress  there,  and  had 
gained  some  ground,  when  it  encountered  an  impassioned  and  powerful 
adversary,  who,  employing  by  turns  the  lights  of  observation,  and  the 
weapons  of  dialectics,  assaulted  it,  piece  by  piece,  and  gave  it  no  quarter 
imtil  he  had  laid  bare,  and  fully  exposed,  its  vices  and  its  dangers. 
Brown  stopped  to  consider,  at  this  superficial  and  common  observation, 
that  in  the  greater  number  of  diseases  there  is  a  diminution  of  the 
general  forces ;  and  without  troubling  himself  about  the  condition  of 
the  organs,  he  hastened  to  conclude  that  it  is  necessary  in  nearly  every 
case  to  administer  tonics  and  stimulants.  Broussais,  penetrating  further 
in  his  observations  of  morbid  phenomena,  demonstrated  that  the  general 
debility  of  the  sick  coincides  more  frequently  with  an  exaltation  of  the 
sensibility  of  organs  ;  whence  he  concludes,  that  far  from  attacking 
these  organs  with  stimulants  stronger  than  usual,  it  is  necessary,  on 
the  contrary,  to  diminish  the  energy  of  the  habitual  stimulation — that 

"  Biographic  Medicale,  art.  Brown.    Paris,  1820. 


THEORIES   AND   SYSTEMS.  561 

is  to  say,  employ  debilitants  and  sedatives.-'  If  we  may  reproacli  the 
French  pathologist  for  having  maintained  the  narrow  base  of  Brunonism 
in  establishing  his  nosological  classification  on  the  want  or  excess  of 
irritation,  it  is  no  less  true  that  he  has  rendered  an  eminent  service  to 
science  and  humanity,  in  giving  the  precept,  to  proportion  the  degree  of 
stimulation  to  the  receptive  condition  of  the  organs,  rather  than  to  the 
general  state  of  the  forces,  because,  in  the  greatest  number  of  cases, 
extreme  prostration  is  accompanied  with  great  irritability  ;  in  other 
words,  a  very  slight  tolerance  for  stimulants. 


ART.    VII.     EMPIRICISM. 

From  Galen  to  an  epoch  very  close  to  ours,  the  Empirical  doctrine  was 
not  professed  openly  by  any  physician  of  reputation.  This  doctrine, 
which  threw  so  much  eclat  over  the  school  at  Alexandria,  had  fallen 
into  such  discredit  that  not  a  single  writer  of  the  middle  ages,  or  on 
the  revival  of  letters,  had  dared  declare  himself  in  its  favor.  Its  name 
became  the  synonym  of  folly  and  charlatanism,  and  implied,  then,  the 
absence  of  all  rational  notions  in  the  Healing  Art.  An  empiric  was  a 
man  who  ordered  remedies  without  any  appreciation  of  their  therapeu- 
tical effects,  without  any  discernment  of  the  diseases  for  which  he 
employed  them. 

We  have  developed,  heretofore,  the  causes  of  the  fall  of  Empiricism, 
and  the  contempt  which  was  attached  to  its  name.  We  have  demon- 
strated that  the  principal  of  these  causes  consisted  in  the  opposition 
that  existed  between  this  medical  system  and  the  philosophical  theories 
then  prevailing.  All  the  ancient  philosophers,  in  fact,  to  whatever  sect 
they  belonged,  agreed  in  saying  that  the  study  and  exposition  of  any 
science  whatever,  must  commence  at  its  principles.  Xow,  the  word 
principle  signified,  sometimes,  a  general  proposition,  from  which  might 
be  drawn  a  certain  number  of  particular  properties,  as  a  source,  afonte. 
For  example,  the  proposition,  tioo  quantities  equal  to  a  third,  are  equal 
to  each  other,  is  a  principle,  or  an  axiom  of  mathematics  whence  are 
deduced  a  crowd  of  theorems.  Sometimes  the  same  word  designated  a 
simple  substance,  indivisible,  or  so  considered,  and  concurring  to  the 
formation  of  compound  substances;  thus,  fire,  air,  earth,  and  water 
were  thought  to  be  the  elements  or  principles  of  all  bodies.  In  philo- 
sophy, the  word  principle  designated,  sometimes,  the  first  rudiment  of  an 
organized  body,  the  elementary  fiber,  or,  also,  the  intriusic  and  natural 

•^  See  his  Examen  des  Doctrines  Medicales.    Paris,  ISIG  et  1829. 


562  KEFORM   PERIOD. 

force  whicli  resides  in  living  beings,  and  concurs  witli  exterior  circum- 
stances to  the  production  of  all  the  phenomena  of  their  existence.  In 
fine,  from  etymology,  and  common  use,  principle  is  the  synonym  of 
commencement. 

Consequently,  it  would  have  been  supposed  as  directly  opposite  to 
common  sense,  if  any  one  had  commenced  the  study  of  a  science  by  any 
thing  else  than  its  principles  ;  thus,  the  study  of  physics  was  begun  by 
the  examination  of  the  theory  of  the  elements,  of  that  of  the  atoms, 
etc. ;  in  a  word,  by  the  examination  of  all  the  cosmogenic  theories  pos- 
sible ;  that  is  to  say,  he  must  engage,  from  the  onset,  in  insoluble  ques- 
tions, the  source  of  interminable  discussions.  In  physiology,  he  must 
attend,  in  the  first  place,  to  the  research  for  the  principle  of  life,  and 
the  elements  of  the  human  body  ;  in  pathology,  he  must,  before  every- 
thing else,  determine  the  essence,  the  proximate  cause,  otherwise  called 
the  principle  of  diseases. 

The  Empirics  came  and  declared  all  these  researches  chimerical,  and 
insoluble,  and  regarded  as  mere  dreaming  all  the  speculations  of  the 
philosophers  and  physicians  in  this  respect.  Bold  reformers,  they 
attempted  to  overturn  entirely  the  established  dialectic  order,  and  com- 
menced the  study  of  the  sciences,  by  the  examination  of  facts,  by 
means  of  observation  and  pure  experience  !  They  assumed  that  rea- 
soning should  not  surpass  the  limit  of  sensible  phenomena.  This 
was,  as  is  seen,  to  sap  the  scientific  edifice  at  its  base  and  overturn  all 
received  ideas.  The  minds  of  men  were  not  ready  for  a  reform  so  rad- 
ical, and  they  therefore  must  fail.  The  philosophers,  menaced  by  Empi- 
ricism in  regard  to  what  they  held  most  dear,  their  theories  and  their 
systems,  in  which  was  constituted  the  major  part  of  their  scientific  lum- 
ber, repelled  the  new  doctrine  as  an  enemy  of  all  knowledge ;  they 
loaded  it  with  their  disdain,  denied  it  the  title  of  rational,  and  banished 
it  to  the  domain  of  stupidity.  Such  is  the  history,  summarily,  of 
Empiricism,  up  to  the  seventeenth  century  of  the  Christian  era,  when 
our  Keform  Period  begins. 

At  this  epoch,  a  sect  of  modern  philosophers  started  up,  who  demol- 
ished the  Platonico-peripatetic  philosophy,  and  rebuilt  the  scientific  edi- 
fice on  new  foundations.  Taking  the  sensations  as  the  point  of  departure 
of  our  knowledge,  they  demonstrated  that  the  first  ideas  which  are  formed 
in  our  minds  by  impressions  upon  the  senses,  are  particular  ideas,  relating 
to  individual  objects;  they  proved,  at  hast  for  the  physical  sciences,  that 
general  ideas  and  axioms,  instead  of  being  the  commencement,  the  base 
of  the  scientific  pyramid,  are  its  termination,  its  summit.  They  assumed 
that  our  understanding  can  not  surpass,  in  its  conceptions,  the  limit  of 
observed  facts,  without  falling  into  the  emptiness  of  hypothesis.     This 


THEORIES   AND   SYSTEMS.  563 

was  to  run  full  sail  into  Empiricism.  Thus  the  new  philosophy  was 
called  experimental,  which  signifies  the  same  thing  as  empirical,  and 
those  who  cultivated  it  were  named  sensualists,  or  better,  sensitists, 
because  they  referred  all  our  ideas  to  sensations.  These  philosophers 
proceeded,  in  all  their  reasonings,  from  particulars  to  generals,  that  is  to 
say,  by  induction. 

On  the  other  hand,  the  partisans  of  an  opposite  doctrine,  those  who 
are  now  called  rationalists,  or  spiritualists,  because  they  admit  either 
innate  ideas,  or  modes  of  acquisition  proper  to  the  mind  and  innate  to 
it,  held  to  the  ancient  method,  that  which  goes  from  generals  to  partic- 
ulars, or  deduction ;  but  they  modified  their  doctrine  in  the  sense  that 
they  agreed  that  in  the  order  of  sensible  things,  reason  can  not  pass  the 
limits  of  experience,  without  mistaking  its  rights  and  its  powers. 

A  change  so  profound  in  philosophy,  and  at  the  same  time  so  favora- 
ble to  Empiricism,  should  have  opened  the  eyes  of  physicians,  and 
caused  them  to  give  up  their  prejudices  against  this  system.  But  ^led- 
icine  is  a  science  so  abstruse,  the  truths  of  which  are  so  diflicult  to 
discern,  and  experience  itself  is  so  deceptive,  that  their  prejudices 
resisted  for  a  long  time  the  progress  of  light,  and  they  could  not  be 
eradicated  but  with  great  pain.  Thus  we  see  the  most  eminent  physi- 
cians of  the  Keform  Period  embarrassed  on  the  subject  of  Empiricism, 
sometimes  branding  this  doctrine  and  its  advocates  with  the  most  oppro- 
bious  epithets ;  again  representing  them  under  much  more  favorable 
colors,  and  even  advantageously ;  sometimes  repelling  their  maxims 
with  disdain,  again  accepting  and  eulogising  them.  This  subject  was, 
for  the  writers  of  the  two  last  centuries,  a  source  of  perpetual 
contradictions. 

We  have  already  quoted  passages  in  which  Baglivi  condemned, 
entirely,  the  Empirical  sect ;  a  little  farther  on  he  changes  his  opinion 
and  speaks  of  them  in  an  entirely  different  manner.  Let  us  recall  only 
the  last  reflection  which  he  has  made  on  this  subject.  "  I  should  not 
think  thus,"  he  says,  "  of  rational  and  learned  Empiricism,  the  fruit  of 
method,  not  of  accident,  directed  and  sustained  by  intelligence,  elevat- 
ing itself  to  the  highest  truths  by  the  attention  and  persevering  obser- 
vation of  phenomena.  Such  an  Empiricism  has  always  obtained  the 
approbation  of  enlightened  men,  who  have  endeavored  to  enlarge  it,  as 
a  mode  of  acquisition  conformed  to  our  nature."  What  other  species  of 
Empiricism  could  have  been  had  in  view  by  those  learned  physicians  of 
Alexandria,  to  whom  Galen  renders  so  honorable  a  testimony,  who  dis- 
daining the  titles  of  Hippocratists,  Herophilians,  Erasistratians,  and 
every  other  denomination  borrowed  from  a  proper  name,  called  themselves 


564  REFORM   PERIOD. 

simply,  experimenters.     It  was  certainly  not  the  Empiricism  of  market 
houses  and  street  corners  that  such  a  class  of  men  avowed. 

Zimmerman,  that  eloquent  though  somewhat  prolix  apologist  of  the 
experimental  method,  does  not  show  himself  more  equitable  nor  more 
consequent  in  regard  to  the  Empirical  sect,  of  whom  he  draws  two  por- 
traits, which  no  one  could  ever  believe  to  have  been  drawn  by  the  same 
hand.  Here  is  the  first:  "  An  empiric  in  Medicine  is  one  who,  without 
dreaming  ever  of  the  operations  of  nature,  such  as  signs,  causes  of  dis- 
eases, indications,  methods,  and  especially  discoveries  of  different  ages, 
asks,  simply,  the  name  of  a  disease,  and  administers  drugs  at  hazard,  or 
distributes  them  at  random,  following  his  routine  and  recognizing  no 
art.  The  experience  of  such  an  Empiric  is  always  false,  because  he 
practices  his  art  without  knowing  it — he  follows  the  recipes  of  others 
without  examining  their  causes,  their  spirit,  and  aim."" 

Here,  now,  is  his  second  portrait,  which  resembles  but  very  little  the 
preceding  one  :  "  Serapion  and  his  successors  opposed  the  research  for 
hidden  causes  and  only  paused  to  consider  those  that  strike  the  senses. 
In  this  they  were  right ;  it  was  reserved  to  anatomy  to  uncover  these 
secret  causes,  but  anatomy  was  still  in  its  infancy  in  the  times  of 
Serapion :  moreover,  causes  at  that  time  were  only  sought  in  philosophy, 
so  that,  necessarily,  they  must  fall  from  one  error  into  another,  in  the 
midst  of  so  much  obscurity.  We  see,  therefore,  that  the  authors  of  the 
Empirical  sect  had  a  design  praiseworthy  only  in  itself. 
They  accepted  only  what  is  appreciable  by  the  senses,  and  consequently, 
they  thought  that  the  senses  and  memory  were  alone  necessary  for  the 
practice  of  Medicine.  If  they  admitted  some  reasoning,  it  was  so  sim- 
ple that  it  was  not  possible  to  be  misled  by  it,  and  so  natural  that  it 
seemed  to  be  self-evident.  They  did  not  proscribe  reasoning  then, 
except  when  it  was  based  on  false  principles,  and  when  nature  was 
judged  by  false  reasoning.  Philinus  and  Serapion,  therefore,  are  not 
to  be  blamed  if  their  sectators  or  successors  have  turned  away  from 
their  manner  of  thinking,  and  if  they  have  condemned  erudition,  anat- 
omy, physiology,  and  philosophy  which  is  the  soul  of  Medicine.  The 
founders  of  Empiricism  sought  true  experience  and  their  stupid  suc- 
cessors content  themselves  with  that  which  is  false." 

It  would  be  easy  for  me  to  establish,  by  a  crowd  of  other  examples 
that  the  same  contradictions  in  regard  to  the  Empirics  and  Empiricism 
are  met  with  among  the  greater  part  of  the  most  celebrated  practitioners 
and  most  renowned  nosologists  of  the  Reform  Period.     To  do  this  I 

"  Traite  de  I'Experience,  translation  of  Lefebre,  Montpellier.     182-i. 


THEORIES  AND   SYSTEMS.  565 

would  only  have  to  open  the  writings  of  Torti,  Sydenham,  Stoll,  Mor- 
gagni,  Sauvages,  Cullen,  Borsieri,  Barthez,  Ph.  Pinel.  I.  P.  Frank,  and 
others ;  in  all  I  could  show  the  maxims  of  the  experimental  philosophy 
adopted,  proclaimed,  and  the  name  of  Empiric  repulsed  and  falsified. 

The  tendency  of  physicians  toward  Empiricism,  became  more  and 
more  marked  toward  the  end  of  the  eighteenth  century.  It  did  not 
escape  the  historian  Sprengel,  who  signalized  it  as  having  had  birth  in 
Gi-eat  Britain,  and  assigned  for  it,  as  principal  causes,  on  one  hand  the 
propagation  of  the  philosophic  principles  of  Bacon,  Locke  and  Hume; 
on  the  other,  the  discovery  of  several  new  medicaments,  the  employment 
of  which  contradicted  all  the  systems  adopted  till  to  that  time,  and 
whose  mode  of  operation  could  not  be  reconciled  with  any  of  the  reign- 
ing theories.  ='•'  He  shows,  afterward,  the  same  tendency  toward 
Empiricism  in  other  countries ;  first  France,  then  G-ermany,  and  extend- 
ing finally  into  all  parts  of  Europe.  "  In  general,"  he  says,  "all  the 
physicians  who  wrote  during  the  last  ten  years  of  the  eighteenth  cen- 
tury seemed  to  be  in  favor  of  Empiricism.  They  inclined  not  toward 
a  blind  routine,  but  endeavored  unceasingly  to  have  their  opinions 
accord  with  experience,  and  never  outstripped  in  their  reasonino- 
the  limits  assigned  by  the  observation  of  nature.  Xo  one  invented  any 
new  theories  on  the  nature  of  the  vital  force,  or  the  essence  of  diseases  • 
and  if  a  few  did  appear,  they  were  received  with  indifference.'--  iS^ever- 
theless,  the  return  toward  Empiricism  was  only  partial,  as  I  have 
already  remarked.  The  greater  part  of  the  writers  in  Medicine  con- 
trived to  mingle  with  their  maxims  of  EmjDirical  philosophy,  researches 
either  on  the  vital  principle,  or  the  fundamental  and  primitive  quality 
of  living  beings ;  on  the  proximate  cause  of  diseases,  their  nature  or 
their  essence — in  a  word,  on  a  crowd  of  subjects  that  are  inappreciable 
to  the  senses.  While  they  criticise  the  explanations  of  their  predeces- 
sors touching  these  abstruse  matters,  they  do  not  hesitate  to  emit  their 
own  opinions  on  the  same  matters,  without  appearing  to  suspect  that 
they  only  substitute  a  new  hypothesis  for  older  ones. 

Thus  Borsieri  de  Kanifeld,  professor  of  Practical  Medicine  in  the 
University  of  Pavia  from  1770  to  1785,  a  learned  writer  and  excellent 
observer,  wishing  to  give  an  idea  of  inflammation,  commences  by  describ- 
ing it  in  these  terms:  "  When  one  realizes  in  a  portion  of  the  body  an 
unnatural  heat,  and  the  part  is  red,  tense,  painful,  with  unpleasant  pul- 
sations, there  is  said  to  exist  an  inflammation  or  pJdogosis,  because 
something  similar  to  the  effects  of  a  burn  is  felt.    If  all  these  accidents, 

'^Hist.  Med.,  section  vi,  chap,  ii,  T.  V  et  VI. 
t  Ibid.     Sec.  xxii,  chap,  i,  T.  VI. 


566  REFORM   PERIOD. 

or  the  most  of  them,  concur  together,  they  constitute  a  disease  named 
by  us  inflammation,  and  by  the  Greeks  phlogosis, — a  disease  whose 
proximate  cause  is  extremely  obscure,  not  to  say  occult,  as  is  shown  by 
the  varieties  and  diflference  in  the  opinions  emitted  on  this  subject."" 

The  above  description  is  clear  to  every  mind.  There  is  no  student 
who.  after  having  read  and  engraved  it  on  his  memory,  if  he  possess 
some  skill  in  clinical  observation,  may  not  be  in  a  state  to  discern  an 
external  inflammation  from  any  other  disease  in  a  certain  phase  of  its 
existence ;  for  it  is  evident  that  phlogosis,  as  well  as  every  other  species 
of  disease  of  the  organism,  does  not  preserve  the  same  morbid  charac- 
ters in  all  the  phases  of  its  existence.  The  botanist  does  not  describe 
otherwise  a  plant,  or  the  chemist  a  salt  or  a  mineral.  Why  then  physi- 
cians ?  When  they  wish  to  explain  a  disease,  do  they  not  content  them- 
selves, in  like  manner,  with  depicting  the  symptoms,  the  march,  the 
termination — in  a  word,  all  the  sensible  and  known  phenomena  as  they 
present  themselves  at  various  stages  ?  Why  do  they  continually  pass 
in  their  speculations  beyond  the  limits  of  pure  observation  ?  It  is 
because  they  are  not  sufficiently  penetrated  by  this  axiom  which  reigns 
in  all  the  philosophy  of  the  physical  sciences :  Reason  was  only  given 
to  us  to  guide  experience ;  and  our  minds,  in  trying  to  pass  the  lim- 
its of  sensations,  mistake  their  rights  as  well  as  their  jjoiver. 

Borsieri,  after  having  thus  described  inflammation,  and  stated  that 
the  proximate  cause  of  disease  is  nearly  impenetrable,  shows  over  twenty 
diff'erent,  and  sometimes  contradictory  theories  emitted  by  the  most  emi- 
nent authors,  from  Hippocrates  to  Boerhaave  and  Haller,  on  the  proxi- 
mate cause  of  inflammation.  It  would  seem,  as  a  natural  conse- 
quence of  this  exposition,  that  Borsieri  would  avoid  all  new  theories  on  the 
same  subject.  Such  is,  nevertheless,  not  the  conclusion  to  which  he 
comes ;  he  has  not  failed  to  propose,  in  his  turn,  an  explanation  more  or 
less  different  from  the  rest,  not  only  on  phlogosis,  but  on  each  of  its 
symptoms.  He  falls  into  a  similar  and  more  striking  inconsistency  still, 
on  the  subject  of  fevers ;  for  having  at  first  affirmed,  in  proper  terms, 
that  it  is  impossible  to  determine  the  proximate  cause  of  this  affection, 
he  has  not  hesitated  to  form,  a  little  farther  on,  conjectures  on  the  cause 
and  mode  of  generation  of  each  of  the  febrile  phenomena.  Borsieri 
was,  nevertheless,  neither  a  transccndentalist  nor  an  enthusiast ;  he  was, 
on  the  contrary,  a  wise  practitioner  and  very  circumspect  theorist,  who 
adopted  no  exclusive  system,  but  who  would  choose  from  each  of  the 

*■' Institutiones  Medicinoe,  De  Inflammatione,  Lipsiae,  1826,  t.  I.,  p.  2.  Com- 
pare this  work  with  that  of  J.  Rasori,  Theorie  de  la  Phlogose,  translated  from 
the  Italian  by  S.  Pirondi,  Paris,  1839. 


THEORIES  AND   SYSTEMS.  567 

prevailing  opinions  of  liis  time  tliat  which  appeared  to  him  most  con- 
formed to  reason  and  experience ;  in  a  word,  he  was  eclectic.  We  see 
by  this  example,  and  by  a  thousand  others  which  have  been,  or  might 
be  cited,  that  there  is  scarcely  a  writer  in  Medicine  who  did  not  surpass, 
in  his  speculations,  the  limits  of  sensible  phenomena ;  that  is  to  say 
who  did  not  fall  into  the  vagueness  of  hypothesis ;  but  in  no  department 
has  the  tendency  of  physicians  for  arbitrary  interpretations  been  more 
striking  and  more  injurious  than  in  therapeutics.  See  in  what  terms  a 
cotemporaneous  author  has  depicted  the  ridiculousness  of  this  mania : 
*'  Intermittent  fevers,"  he  says,  "  are  cured  with  cinchona.  Several 
hundred  volumes  have  been  written  to  explain  the  modus  operandi  of 
this  marvellous  remedy.  This  whole  enormous  aggregation  of  science 
is  not  worth  the  following  line,  and  does  not  go  beyond  it :  for  inter- 
mittent fever,  give  cinchona.  Opium  procures  sleep.  A  multitude  of 
very  learned  writers  have  explained  the  action  of  this  precious  drug. 
Moliere,  in  this  respect,  knew  as  much  as  can  know  to-day  those  who 
have  studied  all  these  beautiful  works :  Opimn  facit  dormire,  quia  in 
eo  est  virtus  dormitiva.  Let  no  one  consider  this  a  detraction  of  Medi- 
cine, for  it  is  the  art  of  curing,  and  not  the  art  of  explaining  cures.  A 
practical  notion,  well  established,  possesses  no  less  dignity  than  a  scien- 
tific principle."" 

Nevertheless,  toward  the  end  of  the  last  century  some  men  made 
praiseworthy  efi"orts  to  banish  from  practical  Medicine  every  species  of 
hypothesis.  Of  this  number  were  Werlhof,  first  physician  to  the  king 
of  England,  at  the  court  of  Hanover,  and  Lieutaud,  first  physician  to 
Louis  XV.  The  former  has  left  a  great  many  writings,  which  are 
remarkable  foi  a  spirit  of  pure  observation,  judicious  principles,  and  an 
elegant  and  pure  style.  He  professes,  on  the  modification  of  remedies, 
on  the  proximate  cause  of  fever  and  its  various  symptoms,  a  prudent 
skepticism,  and  recounts,  in  this  respect,  an  anecdote  which  wc  have 
already  given. f 

The  second  has  already  been  mentioned  advantageously  in  this  Histor3% 
for  his  Historia  Anatomico-Medica,  one  of  the  good  works  which  the 
close  of  the  last  century  produced,  and  for  his  Precis  de  Medecine  Pra- 
tique, an  interesting  composition  in  several  respects,  but  above  all,  by 
the  care  which  the  author  has  taken  to  avoid  all  hypotheses,  and  sub- 
tile and  arbitrary  interpretations.     His  care  is  so  great  in  this  respect, 


*^'  Vues  Pratiques  sur  les  Ameliorations  Agricoles,  '^  '''  par  M.  Dezeiraeris, 
inserees  dans  le  Journal  d'Agriculture  Pratique,  numero  de  juin,  184-"),  tirage  a 
part,  1st  Memoire,  p.  3. 

f  See  chap,  v,  of  this  Period. 


568  REFORM   PERIOD. 

that  not  only  he  abstains  from  all  conjecture  on  the  proximate  cause  of 
diseases,  but  also,  he  avoids  giving  any  definition,  any  general  descrip- 
tion, either  of  fever  or  inflammation.  This  work  was  written,  evi- 
dently, under  the  influence  and  according  to  the  spirit  of  the  philosophy 
of  Condillac,  but  the  absence  of  definitions  and  generalities  does  not 
prevent  the  existence  of  a  little  confusion  and  obscurity  in  the  totality 
of  the  subjects  which  he  presents  ;  so  that  the  judgment  which  Cullcn 
gives  of  it,  though  severe  and  even  partially  inexact,  is  not  without  some 
foundation.  "  It  is,"  he  says,  "a  collection  of  facts  gathered  without 
permitting  himself  to  reason  on  their  causes.  Confusion  and  indecision 
are  the  results  of  its  arrangement.  This  work,  moreover,  is  not  exempt 
from  the  reasonings  that  the  author  pretends  to  avoid."* 

Cullen  is  mistaken  when  he  accuses  Lieutaud  of  being  willing  to 
avoid  every  kind  of  reasoning.  Lieutaud  has  pretended  only  to  avoid 
the  discussions  which  turn  upon  objects  impenetrable  to  the  senses,  such 
as  the  proximate  cause  of  diseases,  the  primordial  properties  of  bodies, 
the  vital  principle,  etc. ;  but  otherwise,  far  from  abstaining  from  rea- 
soning, he  reasons  very  much,  and  even  too  much ;  whence  it  results 
that  his  book  is  rather  critical  than  didactic.  In  this  he  has,  perhaps, 
made  a  mistake,  and  missed  the  end  which  he  wished  to  attain,  as  may 
be  judged  by  the  following  extract  from  his  work,  f 

Thus,  parting  from  the  seventeenth  century,  that  is  to  say,  from  the 
commencement  of  the  philosophic  reform,  we  see  Empiricism  making 
progress   in   Medicine,    though  always   hidden   under   various   names. 

•■'  Cullen,  Elements  of  Mediciue. 

f  Horror  quern  excipit  febris ;  dolor  alterutrius  lateris,  et  plurimum  tamen 
einistri,  sterni,  dorsi,  etc. ;  sputa  cruenta,  et  spirandi  difficultas  sunt  notissima 
peripneumonite,  signa.  Sedulo  animadvertenduni  quod  in  quibusdam  peripneu- 
monia decumbentibus  nulla  erumpant  sputa  cruenta,  licet  pulmones  vera  phlo- 
gosi  corripiantur ;  cur  fit  ut  plurcs  clinici,  duce  Sydenham,  Lunc  aifectum  pro 
peripnevimouia  notha  liabeant;  num  recte  e  mox  narrandis  patebit.  Illudetiam 
notandum  incumbit  quod  pulmonum  phlogosis  baud  semper  tussi,  dolore  et  spi- 
randi difficultate  stipetur ;  uti  grassaute  constitutione  epidemica  175-1,  baud  raro 
inter  rimanda  cadavera  corum  quorum  cura  mihi  demandata  fuerat,  observavi. 
Peripneumoniam  non  numguam  prseeunt  ventris  tormina,  defluxio  anginosa, 
sliusve  morbus  inflammatorius :  nee  infida  in  quibusdam  epidemiis  censentur 
hiBC  prnenuntia-,  in  alia  tempestate  plane  silentia.  De  erysipelate  pulmonum  post 
Hippocratum  et  Galenum,  meutionem  subjecerunt  Lomnius  et  BoerhaaTius ; 
sed  meris  conjecturis  suifulta  est  h^ec  opino;  cum  erysipelas  solam  cutem 
respicere  videatur:  cujus  retrogressu,  materia  morbosa  in  quod  vis  viscos  per 
metastasim  ingruente,  alter  emergit  aifectus,  ob  partis  fabricam  ab  erysipelatis 
indole  profecto  dispar  :  Quod  pace  tantorum  virorum  per  transennam  annotasse 
sufficiat.  (S!/?iopsis  univcrsoi  yraxeos  mediccc,  lib.  I,  sect.  2,  InJIammat to  pectoris,  1. 1, 
p.  168.     Auistelodami,  1725) 


THEORIES   AND   SYSTEMS.  569 

Some  call  it,  with  Sydenham,  the  natural  method,  others  the  method  of 
observation,  experimental,  eclectic,  etc..  Some  even  dare  call  it 
by  its  true  name,  yet  adding  some  corrective,  to  take  from  the  word  the 
idea  of  contempt  which  physicians  commonly  attach  to  it.  Thus  it  is 
called  by  some,  for  this  end,  rational  Empiricism,  the  learned  Empiricism 
of  Baglivi,  Sydenham,  Stoll,  Van  Swieten,  and  Ph.  I'inel,  when  they 
wished  to  have  it  understood  that  in  many  circumstances  these  great 
physicians  made  an  abnegation  of  their  theories,  in  order  to  follow  expe- 
rience only.  If  we  cast  our  eyes  over  the  history  of  Medicine  during 
the  first  half  of  the  nineteenth  century,  we  shall  see  Empiricism  gaining 
more  and  more  ground,  notwithstanding  the  propagation  of  Brunonism 
and  other  new  systems,  among  which  the  system  of  irritation  holds  a 
proper  rank.  We  shall  see,  for  example,  medical  statistics  invoked  by 
the  coryphei  of  all  the  sects,  as  the  supreme  criterion  of  therapeutic 
methods.  Now  statistics  is  pure  Empiricism  ;  it  is  the  negation  of  all 
preconceived  theory.  The  mathematicians  have  never  invoked  this  mode 
of  demonstration  for  their  theorems,  because  by  reasoning  they  make 
them  evident ;  but  in  therapeutics,  where  the  evidence  of  reason  does 
not  exist,  one  is  obliged  to  have  recourse  to  statistics  to  judge  what  is 
the  best  mode  of  treatment  applicable  to  such  or  such  a  morbid  species. 
The  most  determined  adversaries  of  the  employment  of  calculation  in 
Medicine,  agree  however,  that  it  is  legitimate  and  even  necessary,  in 
order  to  obtain  a  judgment  on  therapeutical  methods ;  they  insist,  solely, 
on  the  numerous  sources  of  error,  and  the  extreme  difficulty  of  its 
application.'"' 

Yes,  Empii'icism,  under  whatever  aspect  it  is  viewed,  is  excessively 
difficult,  wc  may  say  even  the  most  difficult  of  all  the  systems  of  Medi- 
cine, in  its  rational  application,  which  will  be  made  clear  by  the  devel- 
opment which  we  shall  presently  give  it.  Whence  it  results  that  far 
from  favoring  idleness  and  ignorance,  as  some  have  believed,  and  others 
have  feigned  to  believe,  it  requires,  on  the  contrary,  the  most  extended 
acquirements  and  most  constant  attention.  It  is,  for  the  most  part,  to 
avoid  the  difficulties  which  it  presents,  that  a  crowd  of  other  systems 

"  F.  .7.  Double  who  exhibits  so  well  these  difficulties  and  causes  of  error,  does 
not  deny  that  statistics  is  definitively  the  best  and  even  the  sole  means  to  judge 
the  relative  value  of  different  modes  of  treatment  used  against  such  and  such  dis- 
eases. See  his  work  TraiM  de  Med.  Pratique,  of  J.  P.  Frank,  translated  into 
French  by  Gonderau.  Paris,  1842. — In  fine,  I  would  formulate  aphoristically 
my  opinion  on  tkis  subject.  I  would  not  say  with  a  cotemporaneous  author : 
Non  soliim  numerandse,  sed  etiam  perpondendoe  sunt  observations  ;  but  I  would 
say :  Primum  perpendendte  sunt  observationes,  deinde  perpendendw  et  iterum 
perpeudendae :   demum  numerandse. 

36 


570  REFORM   PERIOD. 

have  been  imagined,  and  by  turn  abandoned,  then  resumed  again  with 
certain  modifications,  to  be  abandoned  anew  as  false  and  insufficient. 
The  Empirical  doctrine,  alone,  has  never  varied  in  its  fundamental  dog- 
mas :  it  has  marked,  from  its  origin,  the  true  limits  to  which  the  mind 
can  attain :  it  has  traced  the  route  which  it  must  follow  in  the  physical 
sciences.  It  is  the  most  comprehensive  of  all  medical  doctrines,  for  it 
embraces  every  case  in  the  practice ;  it  makes  use  of  notions  suggested 
by  anatomy,  physiology,  chemistry,  physics,  the  various  departments  of 
pathology,  etc.,  more  largely  and  more  surely  than  any  other  doctrine — 
as  any  one  may  be  convinced  by  reading  the  following  chapter. 


CHAPTER    XI. 


EMPIRI- METHODISM;    OR  THE   ALLIANCE  OF  EMPIRICISM  WITH  THE 
PHILOSOPHIC  METHOD. 

There  is  an  axiom  which  reigns  over  the  philosophy  of  causalities, 
which  presides  over  all  the  determinations  of  the  human  will,  whether 
with  or  without  our  apprehension,  to  which  we  give  our  assent  willingly 
or  not,  as  to  a  mathematical  truth.  It  is  the  following:  The  same 
cause,  acting  under  identical  circumstances,  produces,  always,  the  satne 
effect.  If,  in  order  to  make  an  application  of  this  axiom  to  Medicine, 
we  attempt  to  translate  it  into  therapeutic  language,  it  is  presented  in 
the  following  proposition,  which  I  have  before  announced :  A  treatment 
which  has  procured  the  cure  of  any  disease  whatever,  will  cure,  also,  all 
diseases  identical,  or  rather  homogeneous  to  the  first. 

I  have  demonstrated  that  the  physicians  of  primitive  times  had  no 
other  therapeutic  rule,  and  that  they  followed  it  either  from  instinct,  or 
were  led  to  adopt  it  by  their  reason ;  and  I  have  cited,  among  other 
proofs,  the  established  custom  among  several  nations  of  antiquity,  to 
expose  the  sick  in  front  of  their  houses,  so  as  to  attract  the  attention  of 
those  who  passed  by,  that  they  might  suggest  the  remedies  which  they 
had  seen  successfully  employed  in  similar  cases.  I  have  also  shown 
that  the  application  of  this  rule,  the  only  one  in  therapeutics  which  has 
an  absolute  generality,  offers  extreme  difficulties,  which  has  led  to  the 
creation,  successively,  of  the  several  branches  of  medical  science,  their 
numerous  ramifications  and  infinite  details.--^   I  now  resume  the  subject 


'  See  remarks  at  close  of  Mystic  Period. 


EMPIRI  -  METHODISM.  571 

and  deduce  from  it,  by  a  series  of  evident  propositions,  all  the  develope- 
ments  of  the  Empirical  doctrine. 

I  pray  the  reader,  in  the  onset,  to  observe  carefully  that  the  applica- 
tion of  our  fundamental  axiom  in  therapeutic  rests  on  three  rigorous 
conditions,  namely :  homogeneousness  of  diseases,  identity  of  curative 
means,  and  the  knotvledye  of  a  treatment  applicable  to  each  morbid 
species.  Now  to  attain,  if  not  absolutely,  which  is  impossible,  but 
proximately,  these  three  conditions,  all  the  resources  of  science  are  indis- 
pensable, as  we  now  proceed  to  show. 

FIRST   COXDIl'ION — HO.MOGr.N'EOUSNESS    OF    DISEASES. 

Xo  practitioner  has  ever  encountered  two  morbid  states  absolutely 
identical,  and  nature,  perhaps,  does  never  produce  such.  It  is  neces- 
sary, then,  for  the  practitioner  to  content  himself,  from  this  circum- 
stance, with  a  more  or  less  accurate  approximation.  But  at  what  degree 
of  approximation  dare  the  physician  rest,  or,  in  other  terms,  by  what 
signs  shall  he  recognise  that  there  is  enough  resemblance  between  two 
diseases,  one  of  which  is  before  him  and  the  other  has  been  previously 
observed,  in  order  to  treat  the  case  in  hand  with  the  same  remedies 
employed  in  the  former.  In  the  beginning,  they  were  contented  with  a 
very  superficial  similitude  ;  it  sufficed  that  a  patient  present  one  or  two 
symptoms  similar  to  those  of  another,  to  whom  the  same  treatment  had 
been  applied.  It  is,  thus,  under  this  gross  resemblance,  that  ordinary 
men  dare,  every  day,  advise  the  use  of  a  crowd  of  remedies,  and  criticise 
very  often,  even,  those  that  a  physician  has  ordered.  But  men  habitu- 
ated to  the  observation  of  diseases,  cannot  hesitate  to  see  how  much  this 
manner  of  judging  is  false  and  dangerous ;  consequently  they  endeav* 
to  establish  with  more  precision  the  distinctive  characteristics  of  the  mor- 
bid species. 

At  first  it  was  thought,  and  not  without  reason,  that  two  diseases 
approach  so  much  nearer  identity  as  they  present  the  greatest  number 
of  similar  phenomena.  Consequently,  those  only  were  considered  homo- 
geneous which  offered  a  multitude  of  analogous  symptoms  ;  while,  on 
the  other  hand,  it  required  but  few  differences  to  consider  two  affections 
as  heterogeneous.  This  method,  very  simple  and  sure  in  appearance,, 
did  not,  however,  produce  excellent  results ;  the  physicians  of  Cnidus 
had  adopted  it,  and  were  led  as  Hippocrates  said  reproachfullj',  to  mul- 
tiply the  morbid  species  beyond  measure.  Their  pathology  was  con- 
fused and  their  therapeutics  uncertain. 

It  will  be  understood  that  it  does  not  suffice  to  enumerate  the  symp- 
toms of  disease  to  obtain  an  exact  tableau  ;  but  that  it  is  necessary  to 
make  a  choice  in  order  to  bring  into  the  first  sketch,  in  imitation  of 


572  REFORM    PERIOD. 

painters,  the  most  characteristic  traits,  that  is  to  say,  the  greatest 
phenomena ;  secondly,  to  lay  down  the  less  important  symptoms  and 
keep  back,  or  neglect  even  entirely,  the  slight  ones,  or  those  without 
apparent  value  ;  such  was  the  method  of  which  Hippocrates  offers  the 
first  model  in  his  Epidemic  Histories. 

This  manner  of  describing  diseases  was  preferable  to  that  of  the 
Cnideans ;  it  prevailed  universally.  From  that  time  all  the  difficulty, 
or  at  least  the  greatest  difficulty  in  nosography  consisted  in  the  choice  of 
symptoms,  in  the  classification  of  morbid  phenomena.  Which  among 
these  phenomena  are  those  that  should  be  considered  in  the  first, 
second,  and  third  rank,  and  so  on  for  the  rest  ?  Which  those  that 
should  be  neglected  ?  Such  was  the  great  problem  that  the  Hippocratic 
method  proposed  for  solution  :  up  to  that  time  science  had  marched 
slowly,  noiselessly,  and  with  centenary  steps.  But  at  this  epoch  the 
philosophers  having  taken  possession  of  the  mind,  disputed,  boisterously, 
for  the  sceptre  of  the  intellectual  empire ;  they  divided  themselves  into 
rival  sects,  each  of  which  pretended  to  explain  the  enigma  of  the 
universe,  and  pronounced  definitely  on  the  true  method  of  interpreting 
the  phenomena  of  nature.  Physicians,  also,  after  the  example  of  phi- 
losophers in  order  to  give  the  explanation  of  the  phenomena  of  the 
animal  economy — went  back  to  the  sources  of  life,  to  determine  the 
proximate  cause,  the  principle  of  the  phenomena  of  morbid  affections, 
and  deduce  from  them  an  invariable  method  of  treatment.  They  also 
wished  to  make  science  complete. 

Nevertheless,  observation  does  reveal  to  us  neither  the  primitive 
causes  nor  principles  of  phenomena :  it  shows  everywhere  a  circular  con- 
fiection  of  phenomena,  which  are  all,  by  turns,  both  effects  and  causes ; 
but  it  nowhere  exhibits  the  first  link.  Nature,  as  had  said  Baglivi,  and 
before  him  Hippocrates,  and  many  others — nature  is  a  circle,  of  which 
the  eye  of  man  can  discover  neither  the  beginning  nor  the  end.  There- 
fore, the  research  for  this  beginning  or  the  end,  is  a  vain  and  super- 
fluous undertaking,  in  which  it  is  unreasonable  to  persist.  This  is  the 
place  to  say  with  Meibomius  and  Werlhof :  "  Seek  not  to  know  what  the 
Supreme  Master  has  been  willing  to  conceal ;  it  is  but  learned  ignorance." 
But  most  of  the  philosophers  and  physicians  did  not  possess  this  wise 
resignation.  The  physicians,  for  example,  not  being  able  to  determine 
by  direct  observation,  the  proximate  cause  or  the  initial  phenomenon  of 
diseases,  abandoned,  like  the  philosophers,  the  route  of  pure  experience, 
and  flattered  themselves  with  being  able  to  resolve  the  gi-eat  problem 
which  they  pursued  by  the  aid  of  speculative  considerations.  They  were 
ignorant  at  that  time,  that  in  regard  to  physics  the  human  intelligence 


I 


I 


EMPIRI  -  METHODISM.  573 

can  never  surpass  the  limited  borizon  of  tlie  senses ;  that  bejond  this 
horizon,  there  exists  nothing  but  fiction  and  hypothesis. 

It  required  no  less  than  two  thousand  years  for  the  human  mind  to 
be  convinced  of  this  truth,  and  to  consent  to  restrain  itself  within  the 
limits  which  the  Sovereign  Creator  has  imposed  to  it;  limits  which 
humilitate  its  pride,  and  put  a  rein  on  its  ambition  for  knowledge.  It 
is  only  after  having  essayed  by  all  imaginable  hypotheses,  and  after 
ramblinu  in  every  possible  direction,  that  philosophers  and  physicians 
have  returned  to  their  true  sphere,  that  is  to  say,  that  they  have  recog- 
nized that  the  intelligence  should  not  and  is  not  able  to  pass  the  sensations, 
in  things  of  the  material  order.  But  young,  inexperienced,  and  enthusi- 
astic imaginations,  are  always  ready  to  clear  this  circle,  which  seems  to 
them  too  narrow,  in  order  to  wander  in  the  fields  of  infinity,  as  if  it  was 
not  enough  to  leave  to  this  faculty  (imagination),  which  we  call  folle  dv 
logis,  the  sovereign  reign  over  arts  of  amusement  and  the  caprices  of 
fashion,  but  that  it  should  not  be  permitted  to  usurp  the  place  of  good 
sense  and  experience,  in  the  search  of  means  proper  to  solace  pain  and 
preserve  health.  What  errors  has  it  not  accredited  in  pathology  !  Not 
to  recall  the  principal  and  most  recent  ones,  have  we  not  had  diseases 
of  the  archeus,  or  the  soul,  or  vital  principal ;  those  proceeding  from  an 
excess  of  eifervessence  in  the  blood,  or  an  acid  or  alkaline  acridness ; 
those  consisting  in  an  obstruction  of  the  capillary  vessels,  or  a  deformity 
of  the  liquid  molecules  ?  Has  it  not  been  pretended  that  all  the  morbid 
species,  however  numerous  or  various  they  appear,  may  be  reduced  to  an 
excess  or  want  of  incitation?  Is  it  not  possible,  lastly,  that  ulterior 
discoveries  in  the  composition  of  the  liquids  or  properties  of  the  solids, 
will  yet  give  rise  to  other  hypotheses  on  the  essence  of  diseases  ? 

But  while  a  crowd  of  theorists  gave  themselves  up  to  the  pursuit  of  that 
chimera  called,  sometimes,  proximate  cause,  sometimes,  essence,  again, 
principle  of  morbid  phenomena,  and  did  nothing  more,  really,  than  pass 
from  one  fiction  to  another,  practitioners,  guided  by  simple  good  sense, 
and  grounded  in  experience,  limited  themselves  to  describe  the  apjiarent 
symptoms,  with  the  evident  causes  of  each  morbid  affection,  and  estab- 
lished on  these  sensible  characteristics  the  distinction  of  species  and 
nosologic  genera.  Such  was  the  course  followed,  not  without  deviation, 
by  the  most  celebrated  nosographers  of  antiquity  and  modern  times  ;  a 
course  which  Torti,  Werlhof,  and  Lieutaud  endeavored  to  re-establish  in 
all  its  purity,  following  in  this  the  track  of  Philinus,  Serapion,  and 
other  famous  Empirics  of  the  school  of  Alexandria.  These,  as  should  be 
remembered,  did  not  make  the  homogeneousness  of  diseases  consist  in 
the  ideal  conformity  of   unique  phenomena,  placed  beyond  the  reach 


574  REFORM   PERIOD. 

of  the  senses,  and  called  proximate  cause,  essense,  intimate  nature, 
primitive  phenomena,  etc.,  but  on  an  evident  conformity,  that  is  to  say. 
in  the  uniform  concurrence  of  the  greatest  number  possible  of  sensible 
circumstances,  anterior  circumstances,  concomitant  symptoms,  and  con- 
secutive phenomena.  They  demanded  that  nothing  of  all  this  should  bo 
neglected — nothing  which  had  been  or  might  become  an  object  of  obser- 
vation— because  for  them  the  totality  of  all  these  things  constituted  the 
true  essence  of  diseases. 

However,  it  is  impossible,  as  we  have  already  said,  in  the  examina- 
tion or  the  description  of  a  morbid  state,  that  an  account  be  made  of 
all  the  circumstances,  for  in  that  case  we  should  fall  into  the  confusion 
with  which  Hippocrates  reproached  the  Cnidians.  Xosography  would 
then  no  longer  offer  a  methodic  succession  of  more  or  less  faithful  and 
recognizable  pictures,  but  an  irregular  assemblage  of  colors  and  traits, 
drawn  at  hazard  on  the  canvas,  leaving  no  more  trace  in  the  memory 
than  the  clouds  which  traverse  the  foggy  sky  of  our  climate,  during  the 
variable  weather  of  spring  and  autumn.  The  homoeopathic  pathology  is 
an  incomparable  model  of  this  kind  ;  the  obscurity,  chaos  and  extrava- 
gance of  Paracelsus  have  been  surpassed  very  far  by  Samuel  Hahne- 
mann, which,  however,  has  not  prevented  the  inventor  of  the  spiritual- 
ized poioder  of  gold  from  finding,  in  our  age,  advocates  and  enthusiasts, 
just  as  the  fabricator  of  potable  gold  found  such  in  his.  But  let  us 
leave,  now,  these  souvenirs,  which  are  already  ancient  history  for  our 
forgetful  epoch,  and  see  after  what  rules  we  may  judge  the  importance 
and  gravity  of  a  morbid  accident,  setting  aside  all  ideas  of  the  vital 
principle  and  primitive  or  exclusively  essential  phenomena. 

The  ancient  Empirics  estimated  the  value  of  a  symptom,  or  patho- 
logical circumstance,  according  to  various  considerations.  Sometimes 
they  had  regard  to  the  character  and  intensity  of  the  symptom ;  thus, 
a  permanent  delirium  appeared  to  them  more  grave  than  a  passing 
one  ;  a  pain  which  nothing  could  assuage,  seemed  to  them  more  unprom- 
ising than  one  which  could  be  easily  calmed  by  some  sedative.  Some- 
times they  had  regard  to  the  importance  of  the  organs  whose  functions 
were  deranged  ;  thus,  difficult  respiration  appeared  to  merit  more  atten- 
tion than  a  difficulty  in  the  movement  of  the  arm  ;  a  rheumatism  of 
the  head  more  than  one  of  the  foot,  things  being  otherwise  equal. 
Sometimes  they  took  into  consideration  the  occasional  or  determining 
cause  of  a  disease,  when  the  specific  influence  of  this  cause  had  been 
an  object  of  observation  ;  if,  for  example,  they  had  to  treat  a  person 
bitten  by  a  serpent,  they  believed  it  very  necessary  to  ascertain  whether 
the  reptile  was  of  the  venomous  species,  or  not,  because  experience  had 
demonstrated  that  this  circumstance  affected  very  greatly  a  wound  of 


EMPIRI-METHODISM.  575 

this  kind.  In  short,  they  were  persuaded  that  the  value  of  a  symptom 
could  vary  from  one  stage  to  another,  as  the  result  of  the  increase  of 
knowledge,  and  change  of  views.  The  history  of  medicine  offers  several 
very  remarkable  examples  of  this  kind  of  variation,  of  which  1  shall 
cite  only  the  following :  before  the  discovery  of  cinchona,  and  even 
for  a  long  time  afterward,  periodicity  had  attracted  the  attention  of 
observers  in  fevers  only,  because  in  these  it  is  extremely  well  marked. 
Nevertheless,  very  little  account  was  made  of  it,  even  in  them,  because 
this  circumstance  was  not  the  source  of  any  special  curative  indication. 
Thus,  Pinel  has  not  separated,  in  his  classification,  intermittent  from 
continued  fevers,  because  he  regarded  periodicity  as  a  secondary  symp- 
tom, which  does  not  change  the  nature  of  the  disease  !  Where  is,  to 
day,  the  pathologist  who  does  not  arrange,  in  a  separate  classification, 
periodic  affections.'-- 

The  following  were,  at  the  end  of  our  Eeform  Period,  the  principal 
characters  which  constituted  the  nature  of  a  disease,  and  according  to 
which  one  morbid  species  was  distinguished  from  another,  by  taking 
account  only  of  the  phenomena  appreciable  by  the  senses :  first,  the 
anterior  circumstances,  which  comprise  the  predisposition,  or  diathesis, 
and  the  determining  or  occasional  causes,  such  as  contagion,  miasmatic 

'"'  Pinel  would  not  have  committed  this  philosophic  heresy,  if  he  had  been  imbued 
with  the  sj^irit  of  our  fifth  aphorism,  an  extract  from  the  doctrine  of  Locke  and 
Condillac:  "Sensible  objects  being  known  to  us  only  by  the  impressions  they 
make  upon  our  senses,  our  minds  can  perceive  nothing  in  these  objects  beyond 
the  sensations  they  excite  in  us.  Thus,  when  any  one  asks  what  is  the  nature 
^  or  essence  of  a  body,  we  can  only  reply  by  announcing  its  sensible  qualities." 
According  to  this  axiom,  if  W3  are  asked  what  is  the  nature  or  essence  of  a 
disease,  we  can  only  reply  by  announcing  its  known  symptoms.  How,  then 
could  it  be  said  that  a  symptom  as  important  as  periodicity,  a  symptom  which  is 
the  source  of  an  entirely  special  kind  of  medication,  does  not  belong  to  the 
nature  of  the  disease  ? 

Thus,  also,  a  few  years  ago,  but  little  attention  was  paid  to  the  quality  of  the 
blood,  in  diseases,  or  at  least  no  one  drew  from  it  a  curative  indication  ;  while 
now,  these  qualities,  being  better  studied,  furnish  precious  signs  for  the  diagnosis 
of  several  very  remarkable  pathological  states — states  that  are  designated,  in  the 
most  recent  writings,  by  the  words  hyperemia,  polytemia,  hypasmia,  antemia, 
hydremia,  which  were  formerly  designated  by  the  terms  sanguineous  plethora, 
chlorosis,  poverty  of  the  blood,  etc.  (See  Essai  d' Hematologic  Pathologiquc,  of  M. 
Professor  Andral,  and  the  Traits  de  Nbsographic  MMicaJa,  of  M.  Professor  Bouillaud, 
in  the  chapter  entitled,  Appendice  aux  deux.  Premieres  Classes  des  Maladies.)  Among 
learned  men  of  France,  and  other  countries,  whose  researches  have  contributed 
greatly  to  clear  up  the  pathology  and  physiology  of  the  blood,  we  must  mention 
Prevost  and  Dumas,  Berzelius,  Denis,  Scudamore,  Schultz,  Nasse,  Huenefeld, 
Lecanu,  Gavarret  and  Delafond  collaborators  with  Andral,  Donne,  Becquerel,  and 
Bodier. 


576  REFORM   PERIOD. 

or  poisonous  infection,  etc.;  second,  the  anatomical  seat  of  the  disease, 
or  the  designation  of  the  organ  or  the  tissue  principally  affected,  and 
sometimes,  but  rarely,  the  indicatiuu  of  a  vitiated  state  of  the  humors ; 
third,  the  mode  and  degree  of  alteration  of  these  organs  in  the  living ; 
fourth,  the  idiopathic  and  sympathetic  functional  troubles,  their  regular 
or  irregular,  continued  or  intermittent  course  ;  fifth,  lastly,  the  anatomical 
lesions,  found  in  those  who  had  succumbed  to  diseases  of  the  same  species. 

We  see  by  this  summary  enumeration  of  circumstances,  what  this 
Empiri-Methodic,  or  Empirico-liatioual  doctrine  takes  into  consideration 
in  the  classification  of  diseases  ;  we  see,  I  say,  that  far  from  neglecting, 
as  has  been  pretended,  the  light  of  anatomy,  physiology,  pathological 
anatomy,  and  other  necessary  sciences  furnished  to  pathology,  it  liiakes, 
on  the  coutraiy,  a  continual  and  very  appropriate  use  of  these  lights, 
only  taking  from  anatomy  the  researches  on  the  elementary  fiber,  and 
primitive  elements  of  bodies  ;  from  physiology,  speculations  on  the  vital 
principle,  proximate  cause,  and  the  initial  phenomena  of  life  ;  in  a  word, 
rejecting  from  each  science,  whose  aid  it  invoked,  only  the  assertions 
which  are  not  sufficiently  justified  by  the  testimony  of  the  senses. 

According  to  Empirico-Eational  doctrine,  the  essence  of  disease 
consists  in  the  totality  of .  their  known  phenomena :  two  diseases  are 
considered  homogeneous,  in  other  words,  of  the  same  species,  and  require  the 
same  treatment,  when  they  present  a  great  similitude  in  the  whole  of 
their  appreciable  symptoms.  Thus,  the  nature  or  essence  of  inflamma- 
tion consists,  according  to  this  doctrine,  in  the  union,  in  the  same 
locality,  of  these  four  symptoms :  heat,  pain,  redness,  and  swelling ;  it 
being  understood  that  these  four  symptoms  constitute  only  one  phase  of 
the  disease,  which  may  present  other  symptoms  at  other  stages  of  its 
existence.  The  Dogmatists,  on  the  contrary,  to  whatever  sect  they 
belong,  whether  they  are  Galenists,  latro-chemists,  Animists,  latro- 
mechanicians,  Dynamists,  etc.,  tlie  Dogmatists,  I  say,  make  the  essence 
,of  disease  consist  in  a  primitive  force,  proximate  cause,  or  initial 
phenomenon,  from  which  they  imagine  all  these  consecutive  accidents, 
all  these  apparent  forms  to  proceed.  The  essence  of  inflammation 
consists,  according  to  the  latro-chemist,  in  the  acid  or  alkaline  acridness. 
which  irritates  the  aff'ected  part ;  according  to  the  Animist,  in  the 
reaction  of  the  vital  principle  against  the  morbiginous  cause  ;  with  the 
latro-mechanician,  in  the  obstruction  of  the  vessels  ;  with  the  Dyuamist, 
in  the  reaction  of  the  organic  fiber  against  an  irritant  principle,  or 
mechanical  obstacle. 

AVe  can  comprehend  by  this  presentation  of  views,  why  the  Empirical 
nosology  always  appeared  superficial  and  changeable :  superficial,  because 
it  stopped  at  simple  appearances,  or  at  sensations  ;  changeable  because, 


EMPIRI-METHOmSM.  577 

embracing  but  known  phenomena,  it  must  change  as  they  increase. 
While  the  Dogmatic  nosology,  in  whatever  form  of  dogmatism  it  is 
studied,  has  always  seemed  to  be  more  profound,  because  it  surpassed, 
by  reasoning,  the  limits  of  the  sensations,  and  more  stable,  because,  as 
it  pretended  to  go  back  to  the  initial  force,  or  phenomenon,  there  seemed 
to  be  nothing  more  essential  to  seek  after.  But  the  apparent  super- 
ficiality of  Empiricism  was  wisdom,  erudita  inscitia — the  specious 
profundity  of  Dogmatism,  an  illusion,  an  optical  error.  The  mobility 
of  Empiricism  has  been,  also,  in  reality,  much  less  great,  much  less 
striking,  than  that  of  Dogmatism  ;  for  the  Empirical  nosography  has 
varied  only  in  details,  while  the  Dogmatic  nosography,  on  the  contrary, 
has  been  overthrown,  from  age  to  age,  in  its  very  foundations.  ■■ 

SECOND   CONDITION — IDENTITY   OF   CVRATIVE   MEANS. 

This  condition,  though  in  general  less  difficult  to  fulfil  than  the  first, 
still  presents  in  certain  cases  grave  difficulties :  first,  because  its  accom- 
plishment does  not  depend  alone  on  the  skill  of  the  physician,  but  on  the 
docility  of  the  patient,  or  the  exactness  and  fidelity  of  the  persons  who 
concur  in  any  manner  whatever  in  the  execution  of  the  treatment: 
second,  because  it  is  not  always  possible  to  place  the  patient  in  the  same 
favorable  hygienic  condition.  Notwithstanding  these  obstacles,  art  is 
here  much  more  powerful,  and  it  is  enabled  to  obtain,  in  the  most  of  cases, 
a  sufficient  approximation.  Nevertheless,  to  attain  this  result,  it  is 
necessary  that  the  man  of  art  possess  sufficiently  extended  notions  on 
natural  history,  physics,  chemistry,  materia  medica  and  pharmacology. 

Thus,  the  more  we  advance  in  the  development  of  the  Empiri-meth- 
odic  doctrine,  the  more  we  are  convinced  that  the  rational  application  of 

"  We  can  represent  the  general  idea  that  physicians  have  had  of  disease,  by 
an  algebraic  formula,  in  the  following  manner ;  Let  A  represent  the  sum  of 
acquired  notions  on  any  disease  by  direct  observation  ;  let  E  represent  the  proxi- 
mate cause,  or  the  primitive  phenomenon,  which,  according  to  the  Dogmatists, 
constitutes  the  morbid  essence — a  sort  of  germ,  whose  successive  evolutions  are 
supposed  to  give  rise  to  all  the  apparent  phenomena. 

For  the  Dogmatists  of  any  epoch  or  sect,  the  idea  of  the  disease,  M,  is  con- 
posed  of  the  sum,  A,  of  the  notions  furnished  by  the  senses,  plus  the  essential 
phenomenon,  E,  which  the  mind  should  perceive  by  the  aid  of  reasoning.  The 
general  pathological  formula  of  this  doctrine  will  be,  then,  M,  the  idea  of  the 
disease,  equals  A,  the  sum  of  the  notions  furnished  by  the  senses,  plus  E,  the 
essential  phenomenon  or  essence  : 

M=A-1-E 
For  the  Empirics  of  all  times,  the  general  idea  of  the  disease,  M,  is  composed 
of  the  sum,  A,  of  the  notions  obtained  by  direct  observation,  which  sum  is  the 
same  for  the  Empirics  and  the  enlightened  Dogmatists  of  the  same  epoch,  plus 


578  REFORM    PERIOD. 

this  doctrine  requires  extremely  varied  knowledge,  constant  attention  and 
great  perspicacity. 

THIRD   CONDITION — KNOWLEDGE   OP    A   TUEATMENT   Arpr.lCAP.LE   TO   EACH   SPECIES   OF   DISEASE. 

It  does  not  suffice  to  discern  one  morbid  species  from  another,  nor  to 
have  at  our  disposal  excellent  remedies :  it  is  necessary  still,  and  it  is  in 
this  that  practical  skill  consists,  to  know  how  to  use  them  appropriately. 
It  is  not  so  much  the  remedy  that  procures  the  cure,  as  the  opportunity 
of  its  application.  This  last  condition  is  the  supreme  end  of  Medicine — 
the  crowning  glory  of  the  Art.  To  arrive  at  the  knowledge  of  curative 
indications,  or  the  opportunity  of  such  or  such  a  mode  of  treatment,  is  the 
principal  object  of  all  therapeutical  researches.  Now  it  must  he  avowed 
that  the  fundamental  axiom  of  Empiricism  does  not  furnish  any  light  to 
direct  us  in  such  researches  ;  it  does  not  at  all  indicate  the  route  to  fol- 
low for  the  discovery  of  curative  means ;  it  presupposes  a  knowledge  of 
these  means,  and  limits  itself  to  tracing  the  manner  of  their  application. 
Administer  in  each  case,  say  the  Empirics,  the  remedies  that  have  best 
succeeded  in  analagous  cases.  Those  philcsophic  physicians  who  were 
not  willing  to  be  guided  by  anything  else  than  rational  experience, 
could  not  have  contented  themselves  with  an  axiom  so  vague  ;  they  must 
have  felt  the  necessity  of  adding  to  this  axiom  some  rules  proper  to  direct 

the  essential  phenomenon,  or  proximate  cause,  which  the  Empirics  regard  as 
inacessible  to  the  penetration  of  man,  and  which  consequently  is,  in  their  eyes, 
an  unknown  quantity,  X.  We  shall  have,  then,  for  the  general  pathological 
formula  of  this  doctrine,  M,  or  the  idea  of  the  disease,  equals  A,  the  sum  of  the 
notions  furnished  by  the  senses,  plus  X,  the  essential  phenomenon : 

M^A-f-X 

These  two  formula  difiFer  only  in  the  value  of  E,  which  the  Dogmatists  professed 
to  know ;  but  which  the  Empirics  considered  as  inaccessible  to  the  understand 
ing,  as  well  as  to  the  senses.  Now,  up  to  this  time,  the  Dogmatists  have  not  been 
able  to  agree  among  themselves  on  the  value  of  the  essential  or  primordial  phe  - 
nomenon,  which  they  suppose  that  they  understand.  Moreover,  it  is  evident 
that  they  will  never  know  its  value,  if  we  can  put  some  confidence  in  the  following 
great  axiom  of  modern  philosophy :  Reason  has  been  given  to  vian  only  to  guide  expe- 
rien.ce;  and  the  mind,  in  wishing  to  surpass  the  limits  of  sensations  in  physical  tilings, 
mistakes  its  rights  as  well  as  its  powers. 

We  conclude  from  the  above  that  the  pathological  formula  of  Empiricism, 
though  in  appearance  less  complete  and  less  profound  than  that  of  the  Dogmatists, 
is,  in  reality,  and  always  will  be,  truer  and  more  exact.  I  do  not  say  with  Con- 
dillac,  that  the  rendering  of  our  reasoning  into  algebraic  language  gives  to  it 
more  certainty,  but  I  say,  simply,  that  it  must  appear  clearer  and  more  precise 
in  the  eyes  of  those  to  whom  this  language  is  familiar. 


EMPIRI  -  METHODISM.  57^ 

them  iu  experimentation  with  remedies.  History  teaches  us  that  they 
traced,  indeed,  very  wise  rules  in  this  respect.  But  before  exhibiting 
these  rules,  let  us  examine,  somewhat,  the  value  of  the  axiom  in  itself. 

This  axiom  has  been  the  object  of  the  most  bitter  criticism  on  the  part 
of  the  most  renowned  philosophers  and  theorists  of  antiquity,  and  of  the 
middle  ages.  They  charge  it  not  with  falsity  or  error — that  were  impos- 
sible— but  with  stupidity.  In  their  view,  to  use  a  remedy  for  the  sole 
motive  that  it  had  cured  in  analagous  cases,  was  to  act  without  reason. 
It  was  necessary,  according  to  them,  to  be  able  to  say,  also,  by  what 
property — by  what  concealed  virtue  this  remedy  cured.  For  myself,  I 
am  transported  with  admiration  and  astonishment  when  I  consider  with 
what  precision  the  corj'jihie  of  antique  Empiricism  have  marked  the 
limits  where  our  minds  must  pause  in  researches  touching  the  action  of 
remedies.  They  were  in  advance,  by  two  thousand  years,  of  the  discov- 
eries of  modern  philosophy.  It  was  too  great  a  diplay  of  genius  :  their 
cotemporaries  were  not  able  to  comprehend  them,  therefore  they  calum- 
niated them.  The  Dogmatists  and  Methodists  are  not  obnoxious,  on  the 
other  hand,  to  the  reproaches  that  have  been  made  to  the  Empirics  ; 
they  have  attempted  to  explain  the  intimate  action  of  remedies,  and  they 
have  fallen  in  this  respect  into  such  ridiculous  aberrations  that  their 
pretentious  babbling  has  been  compared  to  the  filthy  condition  of  the 
Augean  stables.  Let  us  see  how  one  of  the  most  famous  of  modern 
theorists,  Bichat,  has  depicted  the  obscurity,  disorder,  and  incoherence  of 
the  therapeutical  language  of  the  schools:  "  Into  what  errors  he  says, 
"  are  we  not  drawn  in  the  employment  and  the  denomination  of  medica- 
ments ?  Deobstruents  were  created  when  the  theory  of  obstruction  was 
in  vogue.  Incisives  sprung  up  w^hcn  the  viscidity  of  the  humors  was 
held ;  the  expressions  of  dilutants  and  attenuauts,  when  the  ideas 
attached  to  these  terms  were  put  forward,  at  the  same  epoch.  When  it 
was  necessary  to  obtund  the  acrids,  inviscauts  or  incrassants  were 
created,  etc.  Those  who  saw  iu  diseases  nothing  but  the  relaxation  and 
tension  of  the  fibers — the  laxum  and  strictum,  as  they  called  it — 
employed  astringents  and  relaxants.  The  cooling  and  the  heating  reme- 
dies were  employed,  especially  by  those  who  had  particular  regard,  in 
diseases,  to  the  excess  or  want  of  caloric,  etc. 

"  Identical  means  have  had,  often,  different  names,  following  the 
manner  in  which  it  was  supposed  they  acted.  Deobstruents  with  one, 
relaxants  with  another,  refrigerants  with  a  third.  The  same  medica 
ment  has  been  by  turns  employed  with  different,  and  even  opposite 
views;  so  true  is  it,  that  the  mind  of  man  prodeeds  at  hazard,  when  he 
is  led  by  vague  opinions.     =■■'      =■'  Except  the  medicaments  whose 


580  KEFORM    PERIOD. 

effects  are  established  by  strict  ohservation,  as  evacuants,  diuretics,  siala- 
gogues,  antispasmodics,  etc.,  those  consequently  that  act  on  a  specific 
function,  and  what  is  our  knowledge  of  the  rest?"* 

Into  what  strange  ramblings  the  desire  to  explain  the  intimate  action 
of  remedies  led  ancient  medicine  !  But  what  the  genius  of  Bichat  did 
not  perceive  (doubtless  because  a  sufficiently  long  experience  had  not 
ripened  it)  is,  that  all  these  ramblings  have  for  a  principle  and  final 
resume,  the  axiom  of  therapeutics  generally  admitted  still  in  his  time : 
diseases  are  cured  by  their  contraries,  contraria  contrariis  curantur. 
From  the  moment,  indeed,  that  this  axiom  was  admitted,  it  became 
indispensable  to  determine  the  mode  of  action  of  the  morbific  cause,  and 
the  mode  of  action  of  the  remedy,  in  order  to  establish  the  pretended 
antagonism  that  was  supposed  to  exist  between  these  two  powers — 
forces. 

I  have  demonstrated  elsewhere,  in  a  peremptory  manner,  the  falsity 
of  such  a  maxim,  and  the  impossibility  of  its  application.  Henceforth 
this  is  a  fact,  accepted  in  science,  to  which  1  think  it  unneccessary  to 
recur.  But  we  have  seen  set  up,  in  our  day,  another  axiom  which 
aspired  to  take  its  place,  the  falsity  of  which  is  still  more  evident — 
more  palpable.  Indeed,  all  the  arguments  which  we  have  employed 
against  tlie  rule  of  contraries,  are  equally  applicable  to  the  doctrine  of 
similars — of  which  mention  is  made  in  the  Hippocratic  works,  and 
which  a  German  physician  has  attempted  to  generalize.  This  physician, 
having  recognized  by  experience,  as  attentive  and  unprejudiced  observ- 
ers have  done  at  all  times,  the  error  of  the  axiom  which  says  that  dis- 
eases are  cured  by  their  contraries,  imagined,  that  in  order  to  be  right, 
he  had  only  to  take  the  opposite  of  this  maxim.  Consequently,  he  pro- 
claimed that  the  supreme  law  of  all  cures  was  this :  diseases  are  cured 
by  their  similars.  A  small  number  of  particular  facts,  badly  observed 
and  badly  interpi-eted,  appeared  to  him  as  a  beginning  of  demonstra- 
tion. There  needed  nothing  more  to  excite  his  enthusiasm,  and  lead 
him  to  undertake  researches  and  experiments,  followed  with  admirable 
patience,  worthy  of  a  better  cause. 

Nevertheless,  it  was  imjjossible  that  experiments  made  in  good  faith 
should  not  have  demonstrated  to  a  sensible  mind  the  falsity  of  the  law 
of  similars.  Such  appears  to  have  been,  in  fact,  the  result  of  the  first 
homoeopathic  experiments.  But  the  author  held  on  to  his  pretended 
discovery  like  a  sovereign  holds  on  to  his  crown,  a  poet  to  his  verses,  a 
miser  to  his  treasure.  He  speaks  of  it  with  religious  admiration  ;  he 
puts  the  rule  of  similars  above  all  ancient  and  modern  discoveries;  he 

'■*  Anatomie  Generale,  Considerations  Generales. 


EMPIRI-METHODISM.  581 

regards  himself  already  as  the  object  of  grateful  veneration  by  posterity. 
When  such  an  illusion  has  once  entered  into  the  head  of  a  man,  it  is 
very  rare  for  it  to  leave  it.  Kather  than  renounce  it,  such  a  man  will 
shut  his  eyes  to  all  evidence  ;  he  will  even  become  a  martyr,  if  necessary. 
Hahnemann,  who  appeals  unceavsingly  to  pure  experience  when  he 
wishes  to  convince  us  of  the  falsity  of  the  axiom  of  contraries, — this 
same  Hahnemann,  rejects  the  proofs  of  experience,  or  what  amounts  to 
the  same,  he  annuls  it,  when  the  effects  of  his  doctrine  are  in  question ; 
for,  is  it  not  annulling  observation,  to  apply  it  to  objects  inappreciable 
to  the  senses.  ^Yhe^e  is  the  man  who  can  verify  the  observations  of  a 
homoeopath  ?  When  Hahnemann  assures  us,  for  example,  that  the 
quadrillionth  of  a  grain  of  the  powder  of  gold,  mixed  with  one  hundred 
grains  of  an  inert  powder,  has  sufficed,  after  being  triturated  several 
moments,  to  calm  at  once  the  furors  of  a  maniac,  who  can  assure  him- 
self whether  it  is  true  or  not '■■■=?  Xo  one.  Would  you  reiterate  the 
experiment  of  the  apostle  of  homoeopathy  ?  If  you  obtain  a  different 
result,  as  must  be  the  case,  he  will  respond  to  you,  that  you  have  not 
employed  the  exact  dose  of  a  quadrillionth  of  a  grain.  How  will  you 
prove  that  there  is  just  a  quadrillionth  of  a  grain  of  the  powder  of  gold 
mixed  with  a  hundred  grains  of  the  powder  of  sugar,  in  the  flask  that 
you  have  made  him  smell?     That  is  an  impossibility. 

It  is,  then,  physically  impossible,  as  I  have  just  said,  to  verify  the 
exactness  of  a  homoeopathic  experiment.  This  truth  has  been  confirmed 
in  proper  terms  by  Hahnemann  himself.  It  is  diflicult,  he  says,  to 
comply  with  the  request  that  many  persons  have  made  to  me,  to  place 
before  the  eyes  of  the  public  some  examples  of  homoeopathic  cui-es ;  if 
we  should  do  so,  the  mere  reading  of  them  would  be  of  very  little  utility.f 
Hahnemann  has  been  charged  with  empiricism  ;  but  nothing  is  less 
founded  than  this  qualification ;  for  he  entertains  us  unceasingly  on 
the  intimate  nature  of  diseases — the  atomic  or  spiritual  action  of  reme- 
dies. He  shows  the  medicamental  atoms  attaching  themselves  by  elec- 
tion, to  the  molecules  of  the  diseased  part.  In  a  word,  he  transports  us 
continually  beyond  the  phenomena  which  are  appreciable  by  the  senses ; 
that  is  to  say,  into  the  region  of  chimeras.  This  is  clearly  pure  Dog- 
matism, 1)ut  a  dogmatism  which  differs  from  the  ancient  one.  as  the 
homoeopath  attributes  to  the  similitude  of  action  of  the  disease  and  the 
remedy,  the  curative  result  which  the  others  attributed  to  their  antago- 
nism.    What  deceives  superficial  readers,  and  leads  them  to  believe  that 

'*  See  the  Traite  de  Matiere  Medicale  ou  de  I'Action  pure  des  MedicamentB 
Homoeopathiques,  by  S.  Hahnemann,  Paris,  1834.     Vol.  I,  p.  79. 
tibid. 


682  REFORM    PERIOD. 

homceopathy  is  related  to  empiricism,  is  the  eulogy  that  Hahnemann 
ceases  not  to  bestow  upon  pui-e  experiment ;  for  he  continually  alludes 
to  it.  But  this  appeal  is  only  formal.  We  know  now  how  little  impor- 
tance he  attaches  to  the  decisions  of  experience,  and  how  hard  he  tried 
to  annihilate  them. 

If  there  should  remain  still  a  shadow  of  doubt  in  the  minds  of  my  read- 
ers concerning  the  falsity  and  the  nullity,  whether  of  the  axiom  of  contra- 
ries or  the  axiom  of  similars,  it  will  suffice  to  convince  them  irresistibly, 
by  reminding  them  of  this  sentence  of  Hume,  which  I  have  already 
quoted  after  Barthez,  and  upon  which  all  the  philosophers  now  agree: 
"  It  does  not  appear  that  any  corporeal  action,  nor  any  action  of  the  soul 
upon  its  own  faculties  or  ideas,  can  enable  us  to  conceive  the  acting 
force  of  causes,  or  the  necessary  relation  which  they  sustain  to  their 
effects.  In  the  succession  of  natural  phenomena,  nothing  presents  to  us 
the  idea  of  causality,  or  the  connection  of  cause  and  effect.  But  when 
the  succession  of  one  phenomenon  to  another  is  constant,  the  human 
mind,  which  observes  this  assiduously,  and  which  often  even  can  fore- 
see it,  is  led  to  believe  that  these  phenomena  succeed  each  other  because 
they  are  linked  together." 

Thus,  then,  when  the  employment  of  a  therapeutical  agent  is  followed 
constantly,  or  very  frequently,  by  the  cure  of  a  given  disease,  we  are  led 
to  believe  that  the  treatment  employed  is  the  cause  of  the  cure  ;  but 
our  mind  cannot  seize  the  bond  which  unites  these  two  facts  together. 
It  cannot,  therefore,  affirm  that  the  cure  has  taken  place  in  virtue  of  the 
similarity  or  antagonism  of  the  curative  and  the  morbigenous  principle ; 
or  in  virtue  of  any  other  appreciable  connection  between  the  remedy  and 
the  disease.  All  that  we  can  know  certainly — all  that  assiduous  obser- 
vation can  teach  us,  is,  that  the  cure  of  such  a  disease  succeeds  more 
or  less  constantly,  the  administration  of  such  a  remedy. 

Besides,  is  not  this  the  most  important  thing  for  us  to  know  ;  and  the 
best  reason  which  can  be  given  fur  the  employment  of  a  therapeutical 
agent  ?  Have  we  not,  in  this,  certainty,  or,  at  least,  very  great  proba- 
bility that  it  will  cure  ?  In  truth,  the  theorists  who  ask  more  than 
this,  are  very  exacting,  and  somewhat  unreasonable  ;  and  Empirics, 
both  ancient  and  modern,  have  done  well  not  to  seek  any  farther  in 
what  consists  the  curative  virtue  of  remedies,  but  to  concern  themselves, 
with  all  possible  care,  if  a  remedy  cures  often,  or  seldom,  or  never — in 
what  circumstances  it  cures,  and  in  what  it  does  not  cure.  They  have 
marked  the  veritable  limit  which  our  mind  can  attain,  and  where  it 
must  stop  in  therapeutics,  as  well  as  in  pathology.  Ihey  foresaw,  as  I 
have  said  above,  the  discoveries  of  modern  philosophy,  and  thus  pro- 
nounced in  advance,  a  condemnation  of  such  strange   expressions   as 


.1 


EMPIRI-METHODISM.  583 

homceopathy,  antipathy,  allopathy — expressions  as  opposite  to  the  genius 
of  good  medicine  as  sound  etymology. 

x\.ccording  to  the  doctrine  of  Empiricism,  no  one  should  inquire  why 
opium  causes  sleep,  nor  why  cinchona  breaks  a  fever,  but  it  should  be 
ascertained  if  it  is  really  true  that  opium  produces  sleep — if  it  constantly 
has  this  eifect — in  what  state  of  health  it  procures  sleep,  and  in  what 
doses  it  is  to  be  administered  to  cause  this  result.  It  should  be  ascer- 
tained if  cinchona  really  breaks  a  fever — the  kind  of  fever  it  thus  cures, 
and  in  what  doses  it  is  a  febrifuge.  If  the  authors  in  Medicine  w^ere 
only  occupied  with  questions  of  this  kind,  the  only  ones  which  are  effec- 
tually useful,  the  sole  ones  susceptible  of  a  rational  solution,  they  would 
not  be  lead  away  into  a  labyrinth  of  learned  interpretations,  which  have 
become  very  ridiculous ;  they  would  not  have  furnished  so  many  avail- 
able points  for  the  humor  of  our  great  Comic ;  they  would  not  have 
opposed  their  sottish  theoretic  prejudices  to  the  admission  of  the  most 
efficacious  remedies,  such  as  cinchona,  mercury,  vaccination,  etc.  For 
the  doctrine  of  Empiricism  does  not  exclude  in  an  absolute  manner,  any 
curative  proceedure — it  repels  only  the  means  recognized  as  ineffica- 
cious, and  postpones  the  admission  of  those  whose  efficac}'  appears 
doubtful  or  contestable.  To  the  Empiri-methodic  physician  all  means 
that  cure  are  rational,  and  those  which  cure  the  best  are  most  so.  He 
would  not  reject  even  the  globules,  more  or  less  infinitessimal,  of 
Homoeopathy,  nor  the  manipulations  of  the  magnetiser,  if  it  could  be 
shown  by  observations  worthy  of  faith,  that  these  globules  or  these 
passes  cured  frequently  enough  any  given  class  of  diseases. 

The  Empirics,  trusting  to  experience  only  in  the  appreciation  of  the 
value  of  remedies  (and,  as  we  have  just  seen,  there  exists  in  therapeu- 
tics no  more  rational  means  of  appreciating  them),  they  were  obliged  to 
devote  themselves,  with  greatest  care,  to  the  perfection  of  this  means. 
And  this  is  what  they  did.  indeed,  as  we  have  reported  in  the  Anatom- 
ical Period,  when  exhibiting  their  antique  doctrine.  The  following 
is  a  resume  of  the  rules  which  they  drew  up  on  this  subject :  The 
same  medicament  must  have  been  tried  a  great  number  of  times  in  per- 
fectly analogous  cases,  by  different  persons,  capable  of  discovering  the 
homogeneousness  of  morbid  affections,  and  who  were  worthy  of  confi- 
dence. When  a  treatment  had  offered  these  proofs,  and  was  found  to 
be  constantly  efficacious,  then  the  description  of  the  treatment,  and  the 
disease  to  which  applied,  formed  a  theorem.  The  collection  of  these 
theorems  thus  verified,  constituted  the  Healing  Art,  and  he  only 
possessed  Empiricism  who  kept  faithfully  in  his  memory  the  totality  of 
its  theorems. 


684  REFORM    PERIOD. 

For  two  thousand  years  these  rules  have  existed,  and  no  notable 
change  has  been  made  in  them,  up  to  the  epoch  when  Barthez  proposed 
his  famous  classification  of  curative  methods.  This  classification,  it 
must  be  confessed,  penetrated  much  farther  than  had  been  done  before 
into  the  mechanism  of  the  operations  of  the  mind  in  therapeutics ;  but 
it  was  neither  complete  nor  free  from  error,  as  I  have  before  shown. 
Barthez  only  had  a  glimpse  of  the  truth — but  he  did  not  seize  nor  make 
himself  master  of  it ;  he  let  it  escape  almost  immediately,  because  he 
was  misled  by  a  false  theory.  By  modifying  his  therapeutic  classifi- 
cation, as  I  have  already  done,  he  had  rendered  it  neai'ly  irreproachable 
for  the  epoch  when  it  appeared.  This  classification,  modified  in  that 
way,  is  still,  to-day,  if  1  am  not  mistaken,  the  best  one  that  has  been 
proposed  on  this  subject.  It  enters,  perfectly,  into  the  Empirico- 
rational  doctrine ;  it  is  the  direct  consequence,  the  natural  develope- 
ment  of  the  therapeutic  axiom  of  this  doctrine — for  this  reason  it  must 
find  its  place  here. 


ON  METHOD  IX  THERAPEUTICS ;  OR  CLASSIFICATION  OF  THE  GENERAL  MODES 

OF  TREATMENT. 

There  are,  in  the  present  state  of  science,  four  general  modes  of  treat- 
ment, namely :  the  synthetic,  analytic,  expectant,  and  explorative  or 
perturbative. 

SYNTHETIC      MODE. 

In  this  mode  the  mind  looks  at  all  the  phenomena  of  a  disease,  as 
forming  an  indivisible  concourse  of  symptoms — a  single  morbid  entity — 
and  it  directs  against  this  entity,  considered  thus  en  masse,  a  medica- 
tion termed  specific.  This  mode  of  treatment,  when  it  is  administered 
apropos,  is  the  most  efficacious — the  most  benefical  of  all.  But  science, 
unfortunately,  possesses  very  few  well  established  specifics,  such  as 
vaccine,  mercury,  and  cinchona,  which  can  be  opposed  to  a  determined 
class  of  diseases.  It  possesses  a  greater  number  of  specifics  for  the  func- 
tions, such  as  various  eccropotics,  sialagogues,  diuretics,  emenagogues, 
etc.,  which,  without  being  endowed  with  a  specificity  as  admirable  as 
the  preceding  nevertheless  render  important  service  in  Medicine  when 
they  are  employed  with  discernment,  an  indispensable  condition,  after 
all,  for  every  species  of  medication. 

The  synthetic  mode  is  not  only  the  most  efficacious  of  the  modes  of 
treatment,  but  is  also  the  most  natural,  the  one  to  which  we  are  most 
instinctively  led.     In  the  first  periods  of  the  history  of  Medicine,  none 


EMPIRI-METHODISM.  585 

but  specific  medicaments,  or  those  held  as  such,  were  employed.  As 
soon  as  a  substance  or  a  medical  preparation  appeared  useful  in  a  dis- 
ease, it  was  designated  by  a  name  which  recalled  these  properties ; 
hence  were  derived  the  denominations,  vulnerary,  scabious,  pulmonary 
therica,  etc.  However,  more  attentive  and  enlightened  observation  not 
having  confirmed  eventually  the  correctness  of  these  denominations,  all 
confidence  was  gradually  lost  in  them,  and  by  an  exaggeration  very 
natural,  the  curative  method  to  which  it  had  given  rise  was  included  in 
the  same  proscription.  The  treatment  by  specifics  was  banished  from 
science,  in  favor  of  a  false  theory,  which  pronounced  the  former  irra- 
tional ;  but  it  could  not  be  ecjually  excluded  from  practice,  because,  in 
reality,  it  was  the  most  efficacious  and  the  most  natural.  It  is  time. 
then,  that  we  restore  it  by  means  of  a  better  theory  to  the  honorable 
rank  to  which  it  is  entitled,  from  the  services  which  art  and  humanity 
receive  daily  at  its  hands. 

ANALYTICAL     MODE. 

This  mode  of  treatment  is  the  only  one  which  has  been  well  described 
and  well  denominated  by  Barthez.  It  consists  in  decomposing  a  disease 
or  concourse  of  symptoms  into  its  elements,  that  is  to  say,  into  seve- 
ral secondary  groups,  to  each  of  which  an  appropriate  treatment  is 
applied,  either  simultaneously  or  successively.  For  example,  in  con- 
vulsive bronchitis  or  whooping  cough,  one  may  combat  the  sanguineous 
congestion,  if  it  is  marked,  by  an  application  of  leeches  ;  the  mucous 
congestion,  by  mild  emeto-cathartics  in  broken  doses  ;  finally,  the  nervous 
element  may  be  attacked  by  means  of  some  narcotic  like  belladonna, 
digitalis,  or  opium. 

This  manner  of  treating  diseases  is  much  less  sure  than  the  preceding, 
and  recourse  is  had  to  it  only  in  aflfections  for  which  there  is  no  known 
specific  remedy.  It  is,  moreover,  of  more  difficult  application,  because 
it  requires,  on  the  part  of  the  practitioner,  one  operation  more  than  the 
former,  viz :  the  analysis  of  the  symptoms  of  a  disease,  which  opera- 
tion presents  sometimes  serious  difficulties,  and  countenances  always 
arbitrariness.  Thus,  in  the  example  referred  to,  it  may  happen 
that  one  physician  gives  priority  to  the  sanguineous  element,  another 
to  the  serous,  a  third  to  the  nervous.  Owing  to  the  fact  that  the  analy- 
sis of  the  morbid  concourse  is  merely  mental,  it  is  ordinarily  very 
difficult  to  decide  which  of  these  elements  has  over  the  others  a  prepon- 
derating influence.  Under  these  circumstances,  the  practitioner  too 
often  suffers  himself  to  be  guided  in  his  choice  by  preconceived  ideas, 
and  the  prejudices  of  systems.  The  Animist,  for  example,  sees  in  every 
thing  a  derangement  of  the  soul,  or  vital  principle,  and  nothing  else ; 
37 


586  REFORM    PERIOD. 

the  Chemist  perceives  nothing  but  the  predominance  of  some  acridness ; 
the  Mechanician,  a  mechanical  obstacle  to  the  circulation  of  the  fluids ; 
and  the  Vitalist,  some  changes  in  the  vital  forces.  It  results  from  this, 
that  analysis  is  not  only  of  difficult  application  in  therapeutics,  but  also 
that  it  leads  strongly  toward  arbitrariness,  to  hypotheses."' 

EXPECTANT     MODE. 

"When  a  disease  has  a  fixed  and  rapid  course,  as  an  ephemeral  fever, 
or  benign  roseola,  a  varioloid,  a  simple  wound  not  involving  any  impor- 
tant part,  etc. ;  when  a  disease,  though  graver,  offers  no  alarming  symp- 
tom, and  seems  to  tend  toward  a  happy  termination  by  the  simple  forces 
of  nature,  as  an  inflammatory  fever  without  any  apparent  phlegmasia  of 

*  We  have  frequently  had  occasion  in  the"  course  of  this  history,  to  show  that 
analysis  is  a  falacious  method,  and  has  been  the  source  of  a  crowd  of  errors  in 
Medicine,  when  it  is  separated  from  synthesis.  Permit  me  to  add  en  passant,  that 
the  same  method  applied  to  morals,  has  given  rise  to  errors  a  hvmdred  times  more 
grievous  still.  If  we  are  not  on  our  guard  against  the  illusions  with  which  it 
fills  our  minds,  under  the  guise  of  exactness,  truth,  and  profundity,  it  will  soon 
dry  up  our  hearts,  and  smother  in  our  souls  every  germ  of  virtue,  every  impulse 
of  courage,  magnanimity,  and  devotion ;  to  substitute  for  them  coldness,  arid 
egotism,  melancholy,  contempt  for  others  and  one's  self.  See  in  the  romance  of 
Alfred  de  Vigny,  entitled:  Cinq  Mars,  ou  ime  Conjuration  sous  Louis  XlII. ;  see 
Isay,  the  conversation  of  Friar  Joseph,  a  man  condemned  by  Richelieu,  with  Cinq 
Mars,  detained  in  prison  and  awaiting  execution,  in  vol.  II,  p.  352,  of  the  fifth 
edition.  Read  from  one  end  to  the  other  the  delightful  creation  of  Xaintaine, 
entitled,  Pecciola,  of  which  the  following  is  a  fragment : 

"A  profound  sadness  took  possession  of  the  Count  de  Charney.  Philosophic  analy- 
sis, notwithstanding  all  his  efforts  to  shake  it  ofi",  reigned  over  his  mind,  controlled 
all  his  aiFections,  tarnished,  contracted,  and  extinguished  the  pleasures  and  luxu- 
ries in  the  midst  of  which  he  lived.  The  eulogies  of  his  friends,  the  caresses  of 
his  mistresses,  were  no  more  to  him  than  the  current  money  with  which  they 
paid  for  the  part  they  took,  of  his  fortune,  and  were  only  a  testimony  of  their 
necessity  to  live  at  his  expense.  Decomposing  and  reducing  every  thing  to  its 
first  elements,  by  this  same  spirit  of  analysis,  he  was  attacked  with  a  singular 
disease.  In  the  tissue  of  the  fine  cloth  of  his  dress,  he  thought  he  detected  the 
odor  of  the  animal  which  furnished  the  wool ;  on  the  silk  of  rich  hanging?,  he 
thought  he  saw  crawl  the  disgusting  worm  which  had  spun  it;  on  his  elegant 
furniture,  his  carpets,  the  bindings  of  his  books,  toys  of  pearl  and  ivory,  he  saw 
nothing  but  spoils  of  death — death  set  off  in  attractive  colors  by  the  sweat  of 
poor  artizans.     Illusion  was  destroyed,  and  the  imagination  paralyzed.^' 

Must  we  conclude  from  these  abuses  of  analysis  that  we  should  proscribe  this 
mode  of  acquisition,  to  which  the  human  mind  is  indebted  for  so  many  discov- 
eries? No,  certainly  not.  Such  is  not  our  intention;  we  have  presented  the 
dangers  and  deceptions  of  analysis,  in  order  that  it  may  not  be  embraced  with 
blind  faith;  just  as  the  ancient  Empirics  assigned  limits  to  reason,  not  to  pro- 
scribe it,  as  they  have  been  accused,  but  to  prevent  its  abuse. 


EMPIRI-METHODISM.  587 

an  organ ;  when  a  disease  presents  itself  in  an  obscure  manner,  and 
there  is  besides  nothing  urgent  in  the  case,  and,  in  a  multitude  of  other 
cases  which  it  would  take  too  long  to  specify,  it  suffices,  in  order  to 
obtain  a  cure,  to  place  the  patient  in  favorable  hygienic  conditions,  pre- 
vent the  commission  of  any  imprudence,  and  direct  the  use  of  a  proper 
regimen. 

Nature,  in  these  cases,  seems  to  take  upon  herself  the  work  of  medi- 
cation ;  the  physician  has  only  to  observe  and  hold  himself  in  expecta- 
tion, to  repress,  if  need  be,  the  deviations  of  medicating  nature,  to 
excite  or  moderate  her  movements,  to  sustain  her  forces,  and  to  aid  her. 
in  a  word,  by  following  the  indications  which  she  furnishes.  The  prac- 
titioner has  been  compared,  in  such  a  case,  sometimes  to  a  servant  or 
minister  who  waits  for  his  actions,  only  the  signal  of  the  master ;  again . 
to  an  idle  spectator ;  but  it  is  evident  that  in  this  case  the  listlessness 
of  the  physician  is  only  apparent,  aud  the  denomination  of  inactive 
medicine,  employed  to  designate  the  treatment,  appears  to  me  improper. 

The  disease,  or  the  concourse  of  symptoms  is  here  considered  as  a  reg- 
ular chain  of  phenomena,  which  nature  excites  for  a  curativ^e  purpose. 
and  it  is  important  not  to  interfere  with  the  spontaneous  tendency  with- 
out absolute  necessity.  This  manner  of  philosophizing  having  been  put 
in  vogue  by  Hippocrates,  those  who  adopted  it  were  named  Hippocratists. 
or  Naturalists.  It  suited  especially  in  the  infancy  of  the  Art,  at  an 
epoch  when  few  or  no  ti'ue  specifics  were  known,  and  when  an  enlight- 
ened use  of  analysis  had  not  yet  been  made.  It  renders  the  practitioner 
circumspect  and  attentive,  which  must  be  to  the  advantage  of  the  pa- 
tient ;  and  it  is  applicable  in  a  multitude  of  cases,  both  acute  and 
chronic. 

But  it  is  evident  that  the  expectant  method  does  not  constitute  all  of 
the  Healing  Art :  that  the  synthetic  is  much  more  prompt  and  sure 
whenever  it  can  be  employed,  and  that  the  analytic  merits  also  in  many 
cases  the  preference.  Generalizing  the  Expectant  method  to  excess, 
under  the  title  of  Hippocratic  or  Natural  method,  is  to  mistake  the 
progress  of  light,  aud  to  chain  the  genius  of  Medicine  to  the  bed  of 
Procrustes, 

EXPLOEING    OR     PEETURBATING     MOPE. 

Ambiguous  or  doubtful  cases  often  occur  in  practice,  which  our  minds 
can  not  associate  in  a  precise  way  to  any  of  the  known  morbid  species  ; 
then  the  physician  prescribes  often,  not  at  hazard,  but  from  choice,  a 
medication  calculated  to  develop  the  characters  of  the  disease  and  clear 
up  his  diagnosis.     His  conduct,  under  these  circumstances,  may  be 


588  REFORM   PERIOD. 

compared  to  that  of  the  chemist  who  employs  a  re-agent  to  recognize  the 
nature  of  a  saline  solution. 

In  other  cases,  unhappily  too  numerous,  the  man  of  Art,  after 
having  exhausted  all  the  rational  means  which  science  has  put 
at  his  disposal,  without  obtaining  any  satisfactory  result,  owing  to 
some  idiosyncracy,  or  other  inexplicable  circumstance,  has  recourse 
to  an  indirect  treatment,  by  which  he  proposes  to  give  a  shock  to  the 
entire  economy,  or  only  to  the  part  affected,  in  order  to  produce  an 
advantageous  and  curative  perturbation.  Such  was  the  object  had  in 
view  by  the  ancient  Methodists  in  inventing  the  metasyncritic  circle ; 
such  is  also  now  our  aim  when  we  order  sea-bathing,  voyages,  mineral 
waters,  hydropathy,  etc.  In  these  cases,  the  physician  is  not  acting 
blindly,  nor  does  he  prescribe  at  hazard,  but  is  guided  by  certain  anal- 
ogies; he  has  regard  to  the  habitudes,  age,  and  temperament  of  the 
patient.  On  this  account,  we  give  also  to  this  mode  of  treatment  the 
title  of  rational ;  we  class  it  in  the  rank  of  therapeutic  methods 
acknowledged  by  science.  But  it  occupies  the  lowest  rank  among  these 
methods,  and  the  progress  of  knowledge  will  more  and  more  restrain  its 
application. 

The  explorative  and  the  perturbative  method,  though  united  here, 
respond  to  two  different  views  of  our  minds,  and  should  have  formed 
two  separate  paragraphs.  I  have  thought  it  proper  to  unite  them 
because  they  both  constitute  a  sort  of  groping,  and  both  also  prove  that 
there  is  in  the  mind  of  him  who  employs  either,  about  the  same  degree 
of  uncertainty  and  hesitation. 

R  £  M  A  E  K  3  . 

It  often  happens  that  in  the  same  disease,  we  are  obliged  to 
employ  several  modes  of  treatment,  or  even  all,  either  collectively  or 
successively.  Example :  I  attended,  some  twelve  years  ago,  a  man 
thirty-five  years  of  age,  small  and  fat,  and  of  a  somewhat  sanguineous 
appearance,  whose  trade  was  shoemaking.  The  first  time  I  saw  him,  he 
complained  of  a  want  of  appetite  without  increase  of  thirst,  a  general 
debility  and  insurmountable  sleepiness.  His  tongue,  his  excretions, 
alvine  and  urinary,  his  digestion,  his  pulse,  his  respiration  and  his  cere- 
bral functions  presented  nothing  abnormal.  I  ordered  some  mustard 
foot-baths,  a  middle  diet,  a  mild  purgative  and  a  promenade  after  meals. 
Three  or  four  days  passed  by  without  any  modification  in  the  state  of 
my  patient  being  visible,  unless  there  was  a  slight  increase  of  the  debil- 
ity and  sleepiness.  I  took  from  his  arm  eighteen  to  twenty  ounces  of 
blood,  continued  the  foot-baths,  the  middle  diet  and  mild  cathartic  every 
other  day.     At  the  end  of  some  days  there  was  no  amelioration;  on  the 


EMPIRI-METHODISM.  689 

contrary,  the  debility  had  increased.  I  questioned  him  anew,  and  he 
told  me  among  a  mass  of  useless  circumlocution,  that  his  greatest  drowsi- 
ness was  about  three  o'clock  in  the  day.  I  called  to  see  him  on  the 
next  day  at  that  hour.  He  was  in  bed.  His  color  was  a  little  more 
than  usual,  but  there  was  no  frequency  of  the  pulse  or  extraordinary 
heat  of  skin.  AVhen  I  shook  him  he  opened  his  eyes,  replied  slowly  but 
correctly  to  m}-  questions,  and  fell  off  with  sleep  in  an  instant.  I 
learned  that  the  propensity  to  sleep  came  on  every  day  between  eleven 
and  twelve  o'clock,  and  ceased  towards  six  or  seven  in  the  evening,  and 
that  it  had  never  been  preceded  by  shivering  or  followed  by  a  sweat.  I 
prescribed  six  grains  of  the  sulphate  of  quinine  to  be  taken  in  the 
evening,  and  a  similar  dose  to  be  taken  at  nine  in  the  morning.  The 
next  day  the  somnolency  was  much  less  urgent,  and  the  prostration  less 
sensible.  The  continuation  of  the  remedy  for  several  days  prevented 
completely  the  return  of  the  soporific  accession  and  the  debility. 

If  any  one  now  wishes  to  SiTi<djze  my  conduct  in  the  management  of 
this  case,  he  will  discover  three  distinct  periods.  In  the  first  I  employed 
the  expectant  method.  Then  I  decomposed  the  concourse  of  symptoms 
conformably  to  the  analytic  method,  and  I  treated  the  symptom  of  cere- 
bral congestion  which  appeared  to  me  to  be  the  most  predominant. 
Finally,  I  considered  the  ensemble  of  the  symptoms  as  a  unit,  and 
treated  him  according  to  the  synthetic  method. 

If  any  one  wishes  to  make  the  analysis  in  the  same  manner  of  any 
other  treatment  whatever,  whether  simple  or  complicated,  medical  or 
surgical,  it  is  easy  to  see  that  each  part  of  the  treatment  conforms  to 
one  of  the  general  modes  explained  above.  Suppose,  for  example,  that 
it  relates  to  an  abdominal  tumor,  whose  extirpation  is  judged  to  be  pos- 
sible. It  is  clear  that  in  this  case  the  synthetic  method  is  first  employed, 
for  the  disease  is  attacked  en  masse,  as  constituting  a  unit.  Thon  the 
wound  is  closed  by  sticking  plasters,  a  simple  dressing  applied,  and  the 
patient  is  directed  to  be  kept  quiet  and  on  proper  diet.  This  is  the 
expectant  division  of  the  treatment ;  the  case  is  left  to  nature.  But 
during  the  course  of  the  cicatrization,  various  accidents  maybe  developed: 
an  inflammatory  fever,  for  example,  may  be  lighted  up.  Then  recourse 
is  had  to  the  analytic  mode  in  attacking  the  sanguineous  element  by 
blood-letting,  and  by  withdrawing  a  portion  of  the  nutrition,  which 
diminishes,  of  course,  the  mass  of  liquids,  and  by  combatting  the  thirst 
and  excess  of  caloric  by  abundant  acidulated  or  mucilaginous  drinks. 
If  hospital  gangrene  supervene,  it  is  treated  by  topical  applications  of 
acids  or  caustics,  with  a  view  to  change  an  ulceration  of  a  malignant 


590  REFORM    PERIOD. 

nature  into  a  simple  ulcer ;  in  other  words,  use  is  made  of  the  pertur- 
bative  method,  because  no  safer  means  is  known  yet  to  arrest  this  griev- 
ous complication. 

Thus,  however  varied  may  be  the  means  employed  in  therapeutics — 
however  diverse  may  be  the  views  of  practitioners,  it  is  evident  that 
their  views  and  their  means  are  all  related  naturally  to  some  one  of  the 
methods  referred  to  in  bur  category  above  given.  Moreover,  our  thera- 
peutic classification  presents  a  regular  gradation  of  the  general  modes 
of  treatment,  from  the  one  which  offers  the  least  chances  of  success  to 
the  one  whose  success  is  nearly  infallible.  It  indicates  more  clearly 
than  has  been  done  heretofore  the  end  that  science  proposes,  which  con- 
sists in  elevating  the  treatment  of  each  disease  to  the  most  perfect  and 
surest  mode,  that  is  to  say,  to  the  synthetic  mode,  contrary  to  the  opin- 
ion of  so  many  theorists,  who  falsified  the  art,  and  diverted  the  minds 
of  practitioners  from  the  true  path  by  tarnishing  with  an  opprobious 
epithet  this  curative  method,  which  they  believed  to  be  injurious. 

CONCLUSIO  N. 

Finally,  the  Empiri-methodic  or  Empirico-rational  system,  whose 
economy  we  have  jiist  summarily  unfolded,  includes  all  branches  of 
medical  science  and  unites  them  by  a  natural  tie,  supported  by  reason 
and  history.  All,  or  nearly  all  the  authors  of  systems  of  Medicine  have 
sought  their  foundation  in  physiology,  whence  they  deduced  first  their 
pathological  theories,  and  lastly,  their  rules  of  treatment.  This  was,  it 
must  be  avowed,  following  an  inverse  march  to  what  nature  and  reason 
indicate.  It  is  therefore  not  astonishing,  however  great  was  the  intel- 
ligence of  these  authors,  that  they  were  led  astray.  Indeed,  if  we  con- 
sult history,  we  see  that  the  first  medical  researches  related  to  thera- 
peutics. Even  before  the  existence  of  the  Art,  therapeutics  was  instinct- 
ively applied.  If  we  interrogate  reason,  we  find  that  therapeutics  is  the 
most  important  branch  of  medicine,  the  center  to  which  should  converge 
the  luminous  rays  that  emanate  from  the  other  branches  of  the  science. 
It  was,  then,  natural  and  reasonable  to  seek  in  therapeutics  the  true 
basis  of  a  medical  system.  This  is  what  was  done  so  happily  and  per- 
spicuously by  the  philosophic  physicians  of  Alexandria,  who  were  the 
first  to  take  the  name  of  Empirics.  It  is  what  I  have  also  undertaken 
to  bring  about  with  the  aid  of  the  few  remains  of  their  doctrine,  the 
lights  of  history  and  of  those  which  modern  philosophy  and  medical 
practice  have  furnished  me.  It  has  been  seen  how,  from  this  axiom,  so 
natural  and  so  incontestible — each  disease  must  be  treated  hy  those  reme- 
dies which  have  succeeded  best  in  similar  cases — we  have  deduced  the 
necessity  of  all  the  branches  of  pathology,  anatomy,  physiology,  etc. 


GENERAL  RESUME.  591 

Would  it  be  too  much  to  afl&rm  that  the  system  Empiri-methodic  is  the 
only  true  and  complete  one  which  has  been  proposed  in  medicine  ?  So 
many  men  of  mind  and  genius  have  been  shown  in  the  course  of  this 
history  to  have  been  in  error  for  having  made  a  similar  assertion  in 
honor  of  other  systems,  it  would  be  temerity  in  me  to  affirm  it,  whatever 
may  be  my  convictions  in  this  respect.  I  affirm  nothing  then,  but  I  await 
with  confidence  the  judgment  of  my  confreres,  and  in  particular  that  of 
the  practitioners,  to  whom  it  appertains,  at  last,  to  pronounce  on  the  value 
of  all  medical  systems. 


CHAPTEE   XII. 

GENERAL    RESUME. 

The  History  of  Medicine,  considered  in  its  totality  from  the  com- 
mencement of  society  to  the  present  epoch,  offers  us  three  principal 
phases,  which  we  have  designated  by  the  names  of  Age  of  Foundation, 
Age  of  Transition  and  Age  of  Eenovation. 

During  the  first  phase,  which  terminated  at  the  death  of  Galen, 
toward  the  end  of  the  second  century  of  the  Christian  era,  we  have 
seen  the  Healing  Art  commence  among  all  nations  in  nearly  the  same 
manner.  We  have  recognized  that  it  was  not  a  pure  invention  of  the 
genius  of  man,  but  that  it  owed  its  origin  on  one  hand  to  the  invincible 
instinct  which  leads  us  to  fly  from  pain  and  seek  means  for  its  relief: 
on  the  other,  to  that  inclination,  eminently  social,  called  sympathy, 
which  impels  us  to  succor  our  fellows  in  their  sufferings. 

The  discovery  of  the  earliest  remedies  was  due  to  accident,  instinct 
and  experience.  But  as  soon  as  a  knowledge  of  a  certain  number  of 
medicaments  applicable  to  some  determined  diseases  had  been  acquired, 
it  became  necessary  to  arrange  this  knowledge  in  an  order  which  wouhl 
render  its  application  more  easy  and  sure.  From  that  time  reason  or 
philosophy  united  with  experience  to  give  perfection  to  the  art.  Thus 
instinct,  accident  and  observation  laid  the  first  foundations  of  the  scien- 
tific edifice,  or  rather  furnished  the  first  materials  ;  reason  came  next, 
to  polish,  cull  and  arrange  these  materials  in  a  suitable  manner,  and 
direct  observation  in  the  search  for  new  facts. 

Thus  far,  reason  had  marched  in  the  rear  of  experience,  or  by  its 
side,  performing  the  offices  of  censor  or  architect ;  but  it  did  not 
precede  it,  it  did  not  pretend,  especially,  to  create  itself  the  material 
which  should  serve  in  the  construction  of  the  monument  of  Medicine.  But 
philosophy  soon  allowed  itself  to  creep  upon  the  steps  of  observation. 


I 


592  REFORM   PERIOD. 

which  furnished  it  but  too  slowly,  with  vague,  limited  and  ver}^  variable 
information.  The  philosophers  abandoned  the  long  and  tortuous  path 
of  experience,  believing  they  could  reach  their  aim  more  speedily  and  ■ 
directly  on  the  wings  of  intelligence,  free  from  the  weight  of  the 
senses.  The  certainty  and  invariableness  of  mathematical  propositions, 
the  grandeur  and  beauty  of  the  maxims  in  morals  and  natural  religion, 
admirable  discoveries,  the  foundation  of  all  social  order,  which  were 
regarded  as  the  fruit  of  the  pure  perceptions  of  the  mind — these  were 
the  motives,  very  excusable  doubtless,  on  which  they  rested,  to  turn 
from  observation,  and  seek  by  the  aid  of  pure  mental  intuition,  the  laws 
which  regulate  physical  phenomena. 

From  that  time,  physicians  proposed  nothing  less  than  to  determine 
the  proximate  cause,  the  principle,  the  essence  of  life  and  diseases,  and 
the  intimate  action  of  remedies.  They  assumed  to  build  upon  this 
basis  the  scientific  monument  of  Medicine.  The  more,  then,  objects 
appeared  to  them  removed  from  the  grasp  of  the  senses,  the  more  they 
judged  them  proper  to  become  a  solid  foundation  for  science — one  that 
would  be  undisturbed  by  the  fluctuations  of  experience,  a  mode  of 
acquisition  which  Hippocrates  had  qualified  as  uncertain,  experientia 
fallax.  Thence  sprung  up  a  crowd  of  hypotheses  and  systems,  which 
struggled  for  supremacy  in  Medicine,  from  Hippocrates  to  Galen.  Their 
founders  flattered  themselves  to  be  able  to  avoid  the  uncertainty  and 
gropings  of  experience,  but  they  fell  into  a  labyrinth  of  imaginary 
speculations,  and  opened  an  illimitable  field  to  controversy.  Physicians 
were  divided,  like  the  philosophers,  into  rival  sects,  whose  disputes  only 
ceased  in  consequence  of  political  events,  and  social  revolutions.  It 
was  during  these  conjunctures  that  the  physician  of  Pergamos,  having 
collected  what  he  found  best  in  the  writings  of  his  predecessors,  com- 
posed from  them  a  body  of  doctrine,  conformed  to  the  reigning  philosophic 
ideas,  in  which  we  meet,  in  some  degree,  all  the  opinions  that  had  been 
in  vogue,  but  over  all  of  which  Hippocratic  Dogmatism  predominates. 

The  scientific  monument  of  Medicine,  thus  constituted,  traversed  the 
Second  Age  without  undergoing  any  notable  change.  The  theories  of 
Galen  were  authority  during  all  this  lapse  of  time ;  his  successors 
aspired  only  to  the  glory  of  interpreting  them,  and  to  add  some 
particular  facts,  some  observations  of  detail,  to  the  heritage  that 
antiquity  had  left  to  them.  There  was  established,  we  do  not  know  at 
what  epoch,  a  strange  but  salutary  opinion,  which  formed  a  line  of  de- 
markation,  a  species  of  antagonism  between  theory  and  practice,  between 
rsason  and  experience.  The  theorist,  it  was  said,  must  proceed  accord- 
ing to  logic,  and  the  practitioner  must  be  guided  by  observation.  By 
means  of  this  singular  expedient  or  this  fiction,  false  theories,  and  a 


GENERAL  RESUME.  593 

deceptive  science,  were  preserved  for  centuries  without  misleading  prac- 
tice too  mucli ;  the  physician  could  reason  badly,  without  much  injury 
to  his  patient,  and  without  depriving  himself  of  the  lights  of  experience. 

Such  is  the  aspect  which  medical  doctrine  presents  at  the  commence- 
ment of  the  Age  of  Eenovation,  and  even  for  a  long  time  afterward. 
We  have  seen  that  at  this  epoch  the  human  mind  awoke  from  its  long 
torpor,  and  signalized  its  revival  by  num-erous  discoveries  and  improve- 
ments. Astronomy,  physics,  chemistry,  and  natural  history,  underwent 
a  complete  revolution,  for  which  they  were  indebted  to  the  direct  observa- 
tion of  phenomena,  and  the  adoption  of  a  logical  method,  formerly 
scarcely  used,  called  induction.  The  mathematicians,  who  were  never 
kd  astray  in  their  abstract  speculations,  and  who  had  made  such 
beautiful  discoveries,  reasoning  by  deduction,  preserved  this  logical 
method,  always  dearer  to  meditative  minds  than  to  observers. 

The  philosophers  were  divided  into  two  classes — one,  including  Des- 
cartes, Leibnitz,  Kant,  and  their  disciples,  considered,  above  all,  the 
activity  of  the  soul  in  the  acquisition  of  knowledge,  and  the  production 
of  moral  acts ;  they  were  called  spiritualists,  and  remained  faithful  to 
the  ancient  form  of  reasoning,  deduction,  after  freeing  it  from  the 
pedantic  dress  of  the  schools.  The  other,  including  Bacon,  Locke, 
Condillac,  and  their  followers,  rather  regarded  the  soul  as  passive,  and 
assumed  that  all  its  faculties,  and  all  its  acts,  are  derived  from  sensi- 
tive impressions ;  they  were  called,  on  this  account,  sensitists,  and 
adopted,  for  their  general  method  of  reasoning,  induction,  which  they 
strove  to  introduce  into  all  the  sciences.  If  I  dare  express  an  opinion 
on  a  subject  so  delicats,  I  would  say  that  the  first, — that  is,  the  spirit- 
ualists— seem  to  me  to  have  better  demonstrated  moral  and  intellectual 
truths,  while  the  second,  or  the  sensitists,  appear  to  me  to  have  traced 
with  more  exactness  the  phenomena  of  matter,  either  organic  or  inorganic, 
and  to  have  better  com2:)rehended  its  laws. 

However  this  may  be,  the  greatest  number  of  physicians  adopted  the 
sensitive  philosophy.  They  all  pretended  to  take  the  sensations,  or  the 
sensible  phenomena,  for  the  basis  of  their  systems,  but  all,  or  nearly  all, 
surpassed,  in  their  theoretic  speculations,  the  horizon  of  these  pheno- 
mena, in  which  they  violated  that  axiom  of  modern  philosophy,  common 
to  Sensualism  and  Spiritualism — reason  has  only  been  given  to  us  to 
guide  experience,  and  the  mind,  in  attempting  to  pass  the  limits  of  the 
sensations,  mistakes  its  right  and  its  poiver.  Hence  the  chimeras  and 
instability  of  recent  medical  theories ;  hence,  also,  the  necessity  of 
prolonging,  indefinitely,  the  divorce  of  theory  and  practice,  of  reason 
and  experience — a  divorce  wliich  the  greatest  practitioners  of  the  last 
centuries  have  often  proclaimed — a  divorce  whose  inconveniences  Baglivi 


594  REFORM   PERIOD. 

was  the  first  to  signalize — which  Weiihof,  Morgagni,  and  Lieutaud, 
with  a  small  number  of  other  writers,  attempted  to  break,  but  which 
will  only  completely  cease  when  all  physicians  shall  be  penetrated  with 
this  truth  :  that  beyond  rational  Empiricism  there  is  for  science  nothing 
but  illusion  or  hypothesis. 

We  have  demonstrated  that  all  systems  of  Medicine  should  be  based 
on  therapeutics,  which  is  contrary  to  the  common  opinion ;  for  all  authors 
who  have  been  authority,  from  the  successors  of  Hippocrates  to  the 
present  epoch,  all,  I  say,  excepting  the  Empirics,  have  endeavored  to 
found  their  systems  on  the  laws  of  physiology.  The  last,  even,  among 
them,  Broussais,  was  willing  to  characterize  his  doctrine  by  the  term 
physiological — a  title  which  we  are  in  no  wise  inclined  to  refuse  to  it, 
no  more  than  that  of  many  others  which  have  preceded  it.  Yes,  the 
theory  of  irritation  is  a  reflection  of  the  physological  ideas  of  its  author  ; 
the  theory  of  incitation  offers  us  an  image  of  the  ideas  of  Brown  on 
the  functions  of  the  animal  economy  ;  the  theory  of  Animism  is  a 
consequence  of  the  manner  in  which  Stahl  conceived  life  to  exist ;  the 
theory  of  four  elements  and  four  humors,  represents  the  intimate  play 
of  the  organs  of  the  living  body,  as  men  figured  them  to  exist  in  the 
times  of  Galen.  It  is  the  same  with  all  other  medical  theories — each 
one  of  them  is  a  deduction  of  some  physiological  idea. 

The  authors  of  these  theories  have  reasoned  as  follows :  To  treat  a 
disease  properly,  we  must  know  its  nature.  Now  the  disease  being 
nothing  else  than  a  derangement  of  health,  or  the  physiological  state  of 
the  body,  it  is  necessary  to  know  in  what  health  consists,  in  order  to 
appreciate  the  derangements  which  take  place — that  is  to  say,  the 
diverse  pathological  states.  This  reasoning,  which  appears  so  just  and 
so  natural  at  first  sight,  is  at  bottom  only  an  extremely  subtile  sophism, 
which  clinical  experience  contradicts  at  every  step.  There  is  a  crowd 
of  diseases  whose  nature,  or  mode  of  formation,  escapes  entirely  our 
researches,  yet  which  we  know  very  well  how  to  cure — there  are  others, 
whose  mode  of  formation  is  much  better  known  to  us,  on  whose  nature 
we  have  more  exact  data,  whose  treatment  is,  nevertheless,  but  little 
improved  thereby. 

If,  on  the  other  hand,  we  go  back  to  the  infancy  of  the  Art,  we  shall 
perceive  that  a  great  many  remedies  were  found  before  reason  had  been 
invoked,  either  on  the  intimate  nature  of  diseases,  or  on  the  principles 
or  primordial  properties  of  living  beings.  Finally,  if  we  follow  the 
history  of  science  from  its  origin  to  our  times,  we  shall  see  the  physio- 
logical systems  vary  infinitely,  and  often  contradict  each  other,  while 
the  manner  of  treating  diseases  has  undergone  much  fewer  changes. 
From  these  facts  we  have  concluded,  experimentally,  that  therapeutics 


GENERAL  EESUME.  595 

cannot  be  deduced  directly  from  physiology ;  but  that  the  precepts  of 
the  first  are,  and  should  remain,  independent  of  the  speculations  of  the 
latter. 

To  those  who  pretend  to  deduce  the  general  rules  of  treatment  from 
some  opinion,  or  physiological  experiment,  we  would  recall  the  axiom  of 
philosophy  already  invoked  by  us  more  than  once :  In  the  succession  of 
natural  phenomena,  nothing  presents  to  us  the  idea  of  causality,  or  the 
necessary  relation  of  cause  and  effect.  But  when  the  succession  of  one 
phenomenon  after  another  is  constant,  the  human  mind,  which  observes 
it  assiduously,  and  which  often  can  foresee  it  even,  is  lead  to  believe 
that  these  phenomena  succeed  each  other  because  they  are  linked  together. 
Thus,  when  the  cure  of  an  order  of  diseases  follows  constantly  the  em- 
ployment of  a  medication,  we  are  lead  to  regard  this  medication  as  the 
cause  of  the  cure  which  follows  its  use ;  but  it  is  impossible  for  us  to 
perceive  the  physiological  reason  of  this  result,  and  it  is,  consequently, 
useless  to  seek  it. 

The  physiologist  must  limit  himself  to  describe  the  functions  of  the 
organism,  without  pretending  to  seize  the  proximate  cause  of  these  func- 
tions. While  he  does  not  content  himself  with  depicting  the  phenomena 
of  the  animal  economy  as  they  are  shown  to  us  by  observation,  but 
flatters  himself  to  be  able  to  determine  by  analysis  the  principle,  or 
essential  phenomenon  of  living  beings,  he  mistakes  his  rights  as  well  as 
his  powers.  He  resembles  the  dog  in  the  fable,  which  dropped  the  sub- 
stance to  seize  the  shadow.  He  forgets  that  life  is  a  finished  circle,  in 
which,  consequently,  there  is  neither  commencement  nor  end — He,  alone, 
who  traced  this  circle,  is  able  to  tell  us  where  it  commences  and 
where  it  ends.  The  man  who  struggles  to  resolve  this  problem,  makes 
greater  proof  of  folly  and  unmeasured  ambition,  than  depth  of  mind. 
Far  from  being  able  to  determine  the  principle  or  essential  phenomenon, 
the  object  of  so  many  vain  speculations  and  researches,  the  physiologists 
have  not  even  been  able  to  assure  themselves,  by  the  most  delicate  obser- 
vations, if  life  commences  in  the  solids  or  liquids ;  for  wherever  life 
exists,  we  find  a  combination  of  liquids  and  solids,  an  assemblage  of 
containing  parts  and  parts  contained — we  cannot  even  conceive  of  life 
without  this  union." 

Thus,  therefore,  the  physiologist  must  limit  himself  to  the  description 
of  the  normal  phenomena  of  the  living  economy — the  pathologist  to 
abnormal  ones,  without  either  of  them  aspiring  to  penetrate  the  prim- 
itive mechanism  of  these  phenomena.     So,  also,  the  therapeutist  should 

"  See,  among  other  works,  in  the  Manual  of  Physiology,  of  J.  Muller,  para- 
graphs relative  to  the  forms  of  organic  matter,  and  organic  properties  of  the  blood. 


596  REFORM   PERIOD. 

base  the  choice  of  the  curative  means  he  employs,  not  on  the  analogies 
perceptible  to  the  understanding  only,  but  on  the  material  and  sensible 
analogies.  Such  is  the  resume  of  the  Empiri-Methodic  doctrine,  toward 
which  the  present  generation  manifestly  inclines,  notwithstanding  some 
divergencies.  It  does  not  require  a  great  prophet  to  foresee  that  before 
a  long  time  shall  have  elapsed,  all  medical  opinions  will  unite  upon  this 
doctrine.  Do  we  not  see  researches  on  specific  medications  everywhere 
multiplied  ?  Does  not  our  age  owe  to  this  order  of  researches  the  discovery 
of  some  precious  remedies  for  diseases,  and  the  improvement  of  several 
others  ?  To  recall  but  the  principal  ones,  we  will  cite  the  extension  of 
the  application  of  the  febrifuge,  par  excellence,  to  all  periodic  affections  ; 
the  propagation  of  vaccination  in  spite  of  all  physiological  theories  ;  the 
introduction  of  iodine  and  its  compounds  in  the  treatment  of  scrofula 
and  constitutional  syphilis  ;  the  employment  of  ergot  in  inertia  of  the 
uterus  and  hemorrhages  that  follow  accouchement ;  the  use  of  tarter 
emetic  in  certain  forms  of  pneumonia,  etc.,  etc.  Are  these  not  results 
which  speak  stronger  in  favor  of  the  specificity  of  certain  remedies 
than  the  sophisms  and  eloquence  of  writers  who  strive  to  lead  the  mind 
in  another  direction,  by  taxing  as  irrational  a  mode  of  treatment  unani- 
mously recognized  as  the  most  efficacious  and  beneficial  ?  The  research 
for  occasional  and  predisposing  causes,  that  is  to  say,  causes  called 
evident,  by  the  ancient  Empirics — is  it  not  prefered  in  some  recent  books 
to  the  research  of  causes  called  intimate,  constitutive,  physiological  and 
essential  ?  From  all  these  signs,  it  is  easy  to  foresee  that  the  definite 
triumph  of  Empiri-Methodism,  otherwise  called  rational  or  philosophic 
Empiricism,  approaches. 

But  let  happen  what  will,  the  first  among  moderns,  I  have  endeavored 
to  revive  the  name  of  the  grand  Empirical  school  of  Alexandria.  1 
have  endeavored  to  resuscitate  and  cause  to  shine  in  greatest  brilliancy 
its  claims  to  glory,  forgotten  or  mistaken  for  two  thousand  years.  I 
have  not  been  content  to  reproduce  this  doctrine,  I  have  sought  its 
enlargement  and  consolidation,  by  basing  it  on  new  philosophic  dogmas 
of  incontestible  evidence,  sustaining  it  by  historic  proofs  sufficient  to 
fasten  conviction  upon  the  most  resisting  minds.  Thus  comprehended 
and  developed,  Empiricism  is,  of  all  the  systems,  the  only  one  which 
furnishes  a  sufficient  reason  for  the  rules  of  the  Healing  Art  observed 
in  all  past  and  present  time ;  the  only  one  which  is  applicable  to  all 
branches  of  Medicine  and  its  accessory  sciences  ;  the  only  one,  in  fine, 
which  gives  a  solution  of  this  capital  problem,  sought  in  vain  by  Bag- 
livi,  and  so  many  other  illustrious  physicians :  the  agreement  of  theory 
with  practice,  of  reason  with  experience.  This  system,  it  is  true,  takes 
from  the  mind  numerous  illusions  which  flatter  our  vanity,  and  which 


GENERAL  RESUME.  597 

become  obstacles  to  its  rapid  propagation,  for  although  the  world  grows 
older,  man  always  remains  a  child,  whom  fictions  amuse.  But  in  a  sci- 
ence like  Medicine,  fictions  are  never  innocent ;  they  have  always  caused 
much  evil,  they  retard  the  progress  of  light  much  more  than  doubt  and 
ignorance. 

In  a  professional  point  of  view,  the  history  of  Medicine  has  offered 
us  four  distinct  phases : 

First,  a  patriarchal  phase,  which  corresponds  to  the  origin  of  society, 
to  an  epoch  when  the  chief  of  a  family  united  in  himself  all  power,  and 
was  the  depository  of  all  traditions  ; 

Second,  a  sacerdotal  phase,  which  reigned  long  in  Egypt,  and  flour- 
ished in  Greece  from  the  Trojan  war  to  Hippocrates,  and  which  reap- 
peared in  Europe  during  the  Middle  Ages ; 

Third,  an  unlicensed  lay  phase,  the  worst  of  all  in  regard  to  the  dig- 
nity and  morality  of  the  profession  ; 

Fourth,  a  licensed,  or  organized  lay  phase,  the  most  perfect  of  all 
known  professional  forms,  the  most  appropriate  to  the  present  state 
of  Europe,  and  the  most  favorable  to  the  progress  of  science  and  art. 


THE    END. 


A.FPENDIX:. 


PHILOSOPHICAL  LETTERS 


MEDICINE  IN  THE  NINETEENTH  CENTUEY. 


FIRST  LETTER. 


MEDICINE    JUDGED    BY    PHYSICIANS. 

You  are  aware,  my  dear  and  worthy  colleague,"  and  it  is  universally 
known,  that  Medicine  and  physicians  have  always  furnished  ample 
material  to  the  wits ;  poets,  philosophers,  novelists,  and  writers  of  all 
descriptions  have  rivaled  each  other  in  the  exercise  of  their  satirical 
humor  on  this  inexhaustible  subject.  But  what  is  not  so  generally 
known,  what  most  persons  have  always  overlooked,  and  what  must  seem 
most  singular  is,  that  the  bitterest  criticisms  which  have  ever  been  made 
upon  medical  science,  and  upon  those  who  cultivate  it,  have  flown  from 
the  pens  of  physicians. 

To  prove  my  assertion,  I  need  not  to  go  back  to  the  dark  picture 
which  Galen  traced  of  the  quackery,  ignorance,  and  avidity  of  his  col- 
leagues at  Eome ;  neither  need  I  recall  the  vulgar  wit  of  a  Cornelius 
Agrippa,  nor  the  sarcasms  of  Guy-Patin.  We  who  are  disciples  of 
Esculapius  attach,  in  general,  but  little  importance  to  the  opinions  and 
labors  of  our  predecessors.  The  sharp  and  ridiculous  pictures  of  Moliere, 
of  the  physicians  of  his  time,  touch  us  but  little,  persuaded,  as  we  are, 
that  we  resemble  the  originals  in  no  respect.  Although  only  two  centu- 
ries separate  us  from  that  epoch,  we  believe  ourselves  to  be  at  an  infinite 


'  This  series  of  Letters  was  addressed  to  the  editor  of  I'  Onion  Medicale  in 
1850. 


600  APPENDIX. 

distance  above  the  errors  and  the  ridiculous  practices  which  the  great 
Comedian  pursued  with  his  shafts,  so  much  progress  does  it  seem  to 
us  that  science  and  Medicine  have  since  made. 

I  shall,  therefore,  not  seek  the  proofs  of  the  fact  above  asserted,  in 
the  ancient  authors,  whose  authority  might  be  questioned.  I  shall  take 
them  from  the  most  recent  writings,  in  order  to  establish  the  evidence 
of  the  truth  of  my  proposition,  that  in  our  days,  as  well  as  formerly,  the 
most  severe  critics  of  the  practice  and  the  science  of  Medicine,  have 
been  physicians  themselves. 


I .     School    of    P  a k i s . 

At  the  commencement  of  our  century,  Bichat  wrote  as  follows : 
"  We  h^ve  yet  had  in  Materia  Medica  no  general  systems  ;  but  this 
science  has  until  now  been  influenced  successively  by  those  who  were 
leaders  in  the  profession,  and  each  one  of  these  has,  if  I  may  say  so, 
forced  upon  it  his  own  views.  Hence  the  vagueness  and  uncertainty 
which  it  presents  to  us  to-day.  An  incoherent  assemblage  of  incoherent 
opinions,  it  is  perhaps,  of  all  the  physiological  sciences,  the  one  which 
shows  plainest  the  contradictions  and  wanderings  of  the  human  mind. 
In  fact,  it  is  no  science  at  all  for  a  methodical  mind,  but  is  a  shapeless 
conglomerate  of  inexact  ideas,  of  observations  often  piTcrile,  of  illusory 
remedies,  and  of  formulas  as  oddly  conceived  as  fastiduously  arranged. 
It  is  said  that  the  practice  of  Medicine  is  repulsive.  I  say  more  than 
this :  it  is,  in  respect  to  its  principles,  taken  from  most  of  our  Materia 
Medicas,  impracticable  for  a  sensible  man.  Except  the  medicaments 
whose  effects  are  fully  established  by  strict  observation,  such  as  evacu- 
ants,  diuretics,  sialagogucs,  anti-spasmodics,  etc.,  that  is,  those  which  act 
upon  a  determined  function,  and  to  what  does  our  knowledge  of  the 
other  articles  amount  ?"'■■■= 

I  have  quoted  this  passage  entire,  notwithstanding  its  length  :  First, 
because  it  contains  the  opinion  of  a  man  of  genius,  and  of  an  able 
experimenter,  whose  ideas  and  discoveries  have  exercised  a  capital  influ- 
ence upon  medical  studies  in  France ;  second,  because  it  indicates  with 
precision  the  original,  radical  defect  of  our  therapeutical  denomina- 
tions ;  third,  finally,  because  it  points  out,  although  somewhat  indis- 
tinctly, the  path  which  must  be  chosen  to  arrive  at  a  better  nomencla- 
ture and  sounder  notions  in  therapeutics.     Except  the  medicaments 

*^'  Bichat,  General  Anatomy,  General  Considerations.    Paris,  1818. 


FIRST   LETTEK.  601 

whose  effect  is  fully  established  by  strict  observation,  such  as  evacu- 
ants,  diuretics,  sialagogues,  etc.,  that  is,  those  which  act  upon  a  specific 
function,  and  what  is  the  amount  of  our  knowledge  of  the  other  articles  ?" 
A  few  years  later,  a  physician  nurtured  in  the  physiological  ideas  of 
Bichat,  and  the  philosophy  of  Condillac  and  Cabanis,  and  strengthened 
also  by  the  observation  of  diseases,  and  by  a  large  practice  in  armies 
and  hospitals,  traced  the  following  picture  of  the  effects  of  Medi- 
cine: "Look  back,"  he  says,  "  and  recall  what  we  have  said  in  regard 
to  the  vices  of  medical  practice ;  imagine,  in  all  parts  of  the  civilized 
world,  legions  of  physicians  who  do  not  even  suspect  the  existence  of 
gastric  inflammation,  nor  the  influence  which  this  phlegmasia  exercises 
upon  the  other  organs ;  see  them  pouring  floods  of  vomits,  purgatives, 
heating  remedies,  as  wine,  alcohol,  liquors  impregnated  with  bituminous 
substances  and  with  phosphorus,  upon  the  sensitive  coats  of  the  phlogosed 
stomach ;  contemplate  the  consequences  of  this  medical  torture,  the 
agitation,  trembling,  convulsions,  andphrenitic  delirium,  the  cries  of  pain, 
tortured  expression  of  face,  and  the  burning  breath  of  all  these  unfor- 
tunate ones  who  beg  for  a  drop  of  water  to  allay  the  thirst  which 
devours  them,  and  then  receiving  as  answer  but  a  new  dose  of  the  poi- 
son which  has  reduced  them  to  that  horrible  state ;  '•■■■ 
and  then  decide  whether  Medicine  has,  until  now,  been  more  useful, 
than  injurious  to  mankind.  I  agree  that  it  has  rendered  suffering 
humanity  the  service  of  offering  it  consolations,  by  lulling  it  continu- 
ally with  illusory  hopes ;  but  you  must  also  agree  that  such  a  utility  is 
far  from  being  sufiicient  to  elevate  Medicine  to  the  came  rank  with  other 
natural  sciences,  but  it  seems  to  reduce  it  to  a  level  with  astrology, 
superstition,  and  all  sorts  of  quackery."-' 

"  Thank  me,  kind  reader,  for  I  have  shown  you  but  one-third  of  this  pic- 
ture, whose  colors  grow  constantly  darker  and  darker.  What  I  have 
given  suffices  to  prove  that  the  epigrams  of  philosophers  and  poets,  upon 
the  faults  of  physicians  and  the  pernicious  effects  of  their  Art,  are  but  fee- 
ble sketches  by  the  side  of  this  picture,  at  once  so  animated  and  so  fright- 
ful. It  would  fill  every  honest  and  sensible  heart  with  disgust  for  the 
practice  of  such  a  profession,  if  the  author  of  this  description  had  not 
placed  the  remedy  by  the  side  of  the  evil  he  paints.  This  remedy,  as 
you  will  understand,  is  nothing  else  than  his  own  doctrine,  in  favor  of 
which,  he  says,  the  statistics  of  mortality  have  already  declared,  and 
which  must  in  a  short  time  have  an  influence  upon  population  more 
marked  even  than  the  discovery  of  vaccination.' ^■\ 

We  shall  see,  a  little  farther  on,  how  these  doctrines  of  the  Val  de 


"  Brouasaig,  Examen  dea  Doctrine  Medicales.  f  Ibid. 

38 


602  APPENDIX. 

Grace  were  appreciated  and  are  appreciated  yet,  by  other  schools.  But 
first  permit  me  to  quote  here  the  opinion  of  one  of  the  most  eminent 
partisans  of  this  doctrine,  now  a  distinguished  professor  of  the  faculty 
of  Paris.  He,  after  giving  the  opinions  of  Pinel,  Bichat,  and  others,  on 
the  practice  of  medicine,  adds  :  "  Considered  in  general,  and  absolutely, 
these  sentences  are  too  severe ;  indeed,  there  are  a  certain  number  of 
diseases  in  whose  treatment  therapeutics  has  attained,  long  since,  a  high 
degree  of  certainty  and  precision.  But  it  is  also  true  that  these 
reproaches  apply  themselves  in  all  their  severity  to  several  points  of  our 
therapeutics."" 

Mr.  Bouillaud  is  not  at  all  an  optimist  in  his  judgment  upon  the  ideas 
and  the  practices  of  his  predecessors ;  still  we  must  praise  him  for 
having  avoided  the  exaggerations  of  his  master  in  this  respect.  He  is 
astonished  to  meet  a  great  many  laymen,  and  even  a  few  colleagues, 
who  ask  him  privately  and  in  good  faith,  if  he  believes  in  Medicine. 
"  In  their  opinion,"  he  says,  "  Medicine  should,  to  a  certain  point,  be 
assimilated  to  the  science  of  those  Augurs  who  could  not  look  each  other 
in  the  face  without  laughing."  M.  Bouillaud  should  rather  be  aston- 
ished that,  after  the  declaration  of  so  many  illustrious  physicians  against 
this  science,  there  are  still  persons  credulous  enough  to  believe  in  it,  and 
bold  enough  to  invoke  its  aid.  Should  not  the  instinct  which  leads  men 
to  trust  in  the  prescriptions  of  an  Art  which  has  been  so  much  derided 
by  its  own  adepts,  be  a  safer  and  surer  guide  than  the  reasoning  of  its 
detractors  ?  This  is  a  very  grave  and  very  difficult  question,  whose  solu- 
tion we  cannot  yet  attempt. 

Let  us  pass  on  to  other  medical  schools,  or  rather  to  other  medical 
sects.  Toward  the  end  of  the  last  century,  Pinel,  in  the  first  edition  of  his 
nosography,  declares  that  he  does  not  propose  any  other  problem  than  the 
following:  "  A  disease  being  given,  determine  its  true  character  and  the 
rank  it  must  take  in  a  nosological  table."  Thus  he  leaves  all  consider- 
ations in  regard  to  treatment,  so  to  say,  in  the  rear.  He  dare  not  lay 
down  one  single  general  proposition  of  therapeutics  ;  not  because  he  is 
unaware  of  the  extreme  importance  of  this  branch  of  science,  but  because 
he  considers  it  too  little  advanced  yet  to  be  comprehended  in  generali- 
ties. The  proof  that  this  was  really  his  thought,  is,  that  twenty  years 
later,  in  a  note  to  the  sixth  edition  of  the  same  work,  he  declares  that 
therapeutics,  or  the  methodical  treatment  of  diseases,  is  one  of  those  parts 
of  Medicine  which  must  undergo  a  general  reform,  and  upon  which  the 
attention  of  true  observers  cannot  be  too  often  invited,  as  a  serious  sub- 
ject of  their  researches." 

*  M.  Bouillaud,  Essai  sur  la  Philosophic  Medicale. 


FIRST    LETTER.  603 

M.  Louis  does  not  accuse  therapeutics  alone  of  being  still  in  infancy, 
but  also  all  other  branches  of  IMedical  science.  "  The  physicians  of 
antiquity  have  given  us,"  he  says,  "very  incomplete  descriptions  of  the 
diseases  which  they  observed.  They  have  left  us  numerous  therapeut- 
ical precepts,  but  they  are  deprived  of  proof.  "  *  The 
modern  physicians  have  scarcely  been  more  successful.  =''  '■'  '^' 
And  still  we  count  among  the  physicians  of  antiquity,  as  well  as  among 
their  successors  down  to  our  days,  illustrious  men,  of  rare  capacities,  who 
apparently  wanted  nothing  to  advance  science,  especially  since  patholog- 
ical anatomy  has  been  allowed  to  be  cultivated  without  opposition.  How, 
then,  is  it  that  science  owes  them  so  little  in  general,  and  that  its  his- 
tory is  in  many  respects  only  that  of  their  errors  or  of  their  systems."  •■' 

M.  Louis  and  M.  Bouillaud  attributed  the  errors  of  the  ancients  to 
the  faults  and  imperfections  of  their  methods  of  examining  diseases. 
Consequently  each  of  them  traced  a  formula  or  a  model  for  clinical  obser- 
vations, to  which  tbey  thought  every  one  should  conform,  in  order  to 
avoid  the  faults  and  errors  with  which  they  reproached  their  predeces- 
sors. They  insist,  also,  in  having  enumerated  all  the  cases  of  success 
or  failure,  in  order  to  appreciate  the  value  of  tbe  different  modes  of  treat- 
ment proposed  for  each  species  of  diseases.  This  is  a  condition  very 
easy  to  fulfil,  and  which  should  never  be  neglected,  although  it  does  not 
possess  all  the  importance  which  these  gentlemen  give  it.  In  fine,  they 
are  both  convinced  that  in  following  the  rules  which  they  prescribe,  we 
shall  march  henceforth,  with  a  firm  step,  in  the  path  of  progress. 

This  seems,  nevertheless,  to  be  an  opinion  contrary  to  that  of  the 
authors  of  a  Treatise  on  Therapeutics,  published  a  few  years  later;  for 
we  read  in  its  preface  the  following  paragraph  :  '-We  do  not  believe  that 
by  a  work  of  the  nature  of  the  present  one,  we  should  or  can  set  right  an 
entire  generation,  which,  according  to  our  opinion,  turns  its  back  on 
truth,  and  which  will  have  to  march,  perhaps  for  some  time  yet,  in  error, 
until  that  shall  fall  by  its  own  consequences."  f 

Thus,  according  to  these  latter,  we  have  not  only  been  in  error  until 
now,  but  we  are  so  yet,  and  are  obliged  to  remain  so  for  an  indefinite  lapse 
of  time.  What,  after  this,  shall  the  mass  of  practitioners  and  students 
do  and  believe,  if  the  teachers  themselves  agree  so  little  with  each  other 
that  every  new  work  which  appears  contains  a  more  or  less  explicit  con- 
demnation of  all  those  that  have  preceded  it  ?     Does  not  this  popular 

''Memoires  de  la  Societe  d'Observationes  Me'dicales.     Year  1837. 

fMM.  Trousseau  et  Pidoux,  Traite  de  Therapeutique  et  de  Matiere  Medicale, 
1841.  In  the  third  edition  of  their  work,  the  authors  give  a  resume'  of  their 
doctrine.  We  shall  spaak  of  this  philosophical  conception  in  the  following 
letter. 


604  APPENDIX. 

medical  saying,  which  is  a  parody  on  the  verses  of  a  cotemporaneous 
poet,  correctly  say : 

''Driven  thus  from  system  to  system,  shall  tve  never  be  able  to  throw 
out  our  anchorV 

Now,  this  want  of  union  which  1  have  pointed  out  as  existing  among 
the  masters  of  this  science,  does  not  relate  to  details  only :  no,  it  is 
mostly  upon  the  very  principles  which  form  the  foundation  of  medical 
science  that  they  disagree.  Each  one  of  these  medical  legislators 
aspires  to  nothing  less  than  to  build  his  ideal  monument  upon  the  ruins 
of  all  others.  They  all  commence  by  destroying  what  exists,  leaving 
to  others  to  build  up  again  when  and  how  they  can. 


§11.    School  of    Montpelmee. 

There  exist,  however,  medical  Faculties  in  France  as  well  as  else- 
where, among  which  the  worship  of  the  ancients  is  held  in  higher  honor 
than  it  is  in  Paris,  and  where  the  respect  for  the  doctrines  of  the  great 
masters  is  transmitted  from  generation  to  generation.  In  Montpellier, 
for  example,  the  physiological  idea  of  Hippocrates,  illuminated  and  ex- 
tended by  Barthez  forms  to  this  day  the  foundation  of  their  medical 
instruction  ;  and  M.  Lordat,  one  of  the  most  distinguished  professors  of 
that  school,  has  lately  published  a  work  consecrated  to  the  development 
and  the  demonstration  of  this  same  Hippocratic  idea.=--= 

Not  that  from  time  to  time  some  discordant  voice  is  not  heard  amid 
this  harmony ;  but  if  some  heresy  does  show  itself  there,  it  does  not 
ostensibly  destroy  the  orthodox  doctrine,  but  rather  softens  and  hides  its 
opposition  under  reverential  forms.  Thus  the  historian  of  the  medical 
doctrine  of  Montpellier,  after  having  enumerated  the  works  of  Barthez, 
and  paid  a  just  tribute  of  praise  to  his  genius,  gives  an  excellent  critique 
of  his  system. f 

He  goes  still  farther.  He  announces  in  different  places  a  maxim, 
which,  if  true,  overthrows  completely  the  medical  doctrine  of  Barthez, 
and  of  all  those  who  have  followed  or  may  yet  follow  the  same  route. 
It  is  as  follows :  "  Physiology  can  not  serve  as  a  basis  for  practical 
medicine." 

Such  a  proposition,  I  repeat  it,  does  i-uin  not  only  the  system,  of  Bar- 
thez, but  also  many  other  ancient  and  modern  systems.  But  M. 
Berard  has  contented  himself  with  announcing  it,  without  supporting  it 

'•'Mt.  Lordat,  Preuves  de  I'Insenescence  du  Sens  intime  de  PHomme.    Mont- 
pellier, 1844. 

f  F.  B^ard,  Doctrine  medicale  de  Montpellier.— Paris,  1836. 


FIRST    LETTER.  605 

by  a  single  direct  proof  ,*  on  this  account  this  bold  proposition,  which 
contains  the  germ  of  an  entire  medical  revolution,  has  passed  by,  so  to 
say,  un  perceived.  So  far  as  I  know,  no  one  has  even  taken  the  pains  either 
to  contradict  it  or  demonstrate  it  formally.  I  shall  endeavor  to  fill  this 
vacuum.  I  shall  discuss,  and  in  another  letter  will  try  to  solve  the 
following  difficult  question,  which  should  be  the  preliminary  of  every 
medical  doctrine :  "  Can  physiology  form  the  base  of  the  practice  of 
Medicine  ?"  In  the  meantime  let  us  continue  our  review  of  the  opin- 
ions of  physicians  in  regard  to  the  theory  and  practice  of  their  Art. 
For  this  purpose  we  will  take  a  look  out  of  France,  in  order  to  see  if  in 
other  countries  there  exist  as  deep  dissensions  on  this  subject  as  there  are 
in  our  own.  We  shall,  as  we  have  done  thus  far,  consider  only  the  cap- 
ital points  of  disagreement,  i.  e.  those  which  have  a  bearing  upon  the 
entire  science,  or  upon  its  fundamental  principles. 


§  Til.     Italian    School. 

At  the  end  of  the  last  century  the  doctrine  of  Brown  was  introduced 
into  Italy,  and  was  received  there  with  enthusiasm.  Easori,  who  had 
studied  it  in  England,  contributed  much  to  its  extension.  This  doctrine, 
as  you  well  know,  recognizes  as  the  cause  of  nearly  all  diseases,  too 
great  force  or  weakness  (sthenia  and  asthenia).  Out  of  one  hundred 
species  of  diseases  there  are  scarcely  three,  according  to  the  tables  of 
Linch,  which  can  be  regarded  as  being  caused  by  an  excess  of  vitality 
or  incitability.  Therefore,  nearly  all  medicaments,  most  all  modifiers  of 
the  human  economy,  are  considered  to  be  stimulants,  and  according  to 
this  system,  the  art  of  the  physician  consist  simply  in  proportioning  the 
force  of  stimulation  to  the  degree  of  asthenia  of  the  patient.  Medical 
science  and  practice  are  both  reduced  by  it  to  their  utmost  degree  of 
simplicity,  which  fact  explains  the  rapid  propagation  of  such  a  system. 

Still,  Easori  himself  perceived,  or  thought  he  perceived,  after  a  few 
years  of  practice,  that  certain  modifiers  did  not  act  by  stimulation,  but 
rather  by  sedation,  or  contra-stimulation,  and  that  a  large  number  of  dis- 
eases were  based,  not  upon  depression  of  vital  forces,  but  upon  their  exal- 
tation. From  that  time  he  became  a  reformer  himself,  and  henceforth 
Italy,  as  well  as  France  and  England,  had  each  her  own  indigenous 
medical  system  founded  upon  the  ruins,  and  to  the  exclusion  of  all 
others. 

"  When  we  think,"  says  one  of  the  most  enlightened  partizans  of 
the  Easorian  doctrine,  "  from  what  sources  the  ancients  obtained  their 
notions  of  materia  medica,  we  can  not  be  astonished  that  Stahl  has 
called  the   pharmacology  of  his  time  a  stable  full  of  offal,  and  that 


606  APPENDIX. 

Bichat  has  judged  so  unfavorably  of  that  of  his  epoch.  ••'  In  this  we  have 
the  condemnation  en  ynasse  of  ancient  Medicine." 

In  speaking  of  cotemporaneous  Medicine  he  says:  "  While  the  art  of 
diagnosis  has  made  immense  progress  in  France,  that  of  the  application 
of  medicaments  has  been  entirely  neglected.  The  special  doctrine  of  re- 
vulsion plays  a  considerable  part  in  the  French  schools.  Formerly  all 
was  sympathy,  consensus,  in  diseases  ;  now  every  thing  is  antagonism 
or  revulsion." 

This  is  as  much  as  to  say,  Frenchmen  understand  diseases  very  well 
but  cannot  cure  them — that  we  treat  them  irrationally.  What  great 
advantage  !  to  be  able  to  explain  to  a  patient  the  nature  of  his  disease, 
to  discuss  with  more  or  less  skill  the  origin,  the  seat,  the  progress,  and 
the  probable  consequences  of  the  affection  of  which  he  suffers,  but  to  be 
unable  to  relieve  him?  What  would  the  irritable  Broussais  have  said 
of  such  a  judgment  on  his  doctrine  ;  he  who  believed  to  see  already  in 
the  diminution  of  mortality  the  happy  results  of  its  propagation ;  he 
who  exalted  its  blessings  as  being  far  above  those  of  vaccination  ?  He 
would,  doubtless,  have  cried  out  against  ignorance,  blindness,  and 
injustice ;  but  that  would  not  have  prevented  strangers  from  exercising 
their  judgment  on  our  Medicine  in  the  same  manner  as  we  judge  theirs. 
i.  e.  from  a  special,  exclusive,  and  unfavorable  point  of  view. 


§  IV.     Parallel  between  the  English,  French,  and  Italian  Doctrines. 

While  in  the  native  country  of  Brown  most  diseases  are  considered  as 
proceeding  from  a  certain  degree  of  feebleness,  a  diminution  of  vitality, 
and  are  combatted  by  an  increase  of  excitation,  in  France  the  disciples 
of  Broussais  considered  most  pathological  alterations  as  the  product  of 
an  excess  of  excitability  or  irritation  ;  and  they  have  nothing  so  much 
at  heart  as  to  calm  this  irritation,  to  extinguish  this  phlogosis  by  means 
of  sedatives  or  antiphlogistics. 

In  Italy  they  agree  with  the  French  in  regard  to  the  nature  of  the 
morbid  affections,  which  are  generally  considered  as  connected  with  a 
sthenic  diathesis,  but  the  former  differ  widely  from  the  latter  in  regard 
to  the  appreciation  and  the  use  of  therapeutic  agents.  The  same  arti- 
cles which  pass  on  the  north  side  of  the  Alps  as  energetic  excitants  and 
powerful  tonics,  pass  on  the  other  side  as  sedatives,  or  hyposfchenics. 
Thus  the  quinine,  which,  in  the  eyes  of  the  French  and  the  English,  is 

'"  Giacomini,  Traite  philosophique   et  experimental  de  Matiere  Medicale,  et  de 
Therapeutique.   French  translation,  hy  M.  Rognetta  and  M.  Monjon.  Paris,  1845 


FIRST   LETTER.  607 

an  excellent  tonic,  has  in  the  eyes  of  an  Italian  only  a  depressive 
hyposthenic  action  ;  cautharides,  mercurials,  iodides,  etc.,  which  in 
France  are  classed  among  the  acrid  poisons  and  irritants,  are  ranged  by 
the  Kasorians  among  the  contra-stimulants  and  sedatives. 

Thus,  then,  we  may  say  that  there  exists  in  Medicine,  as  in  theology, 
an  Anglican,  a  Grallican,  and  an  Ultramontane  doctrine ;  and  these 
medical  doctrines  are  not  distinct  from  each  other  by  mere  shades  of  dif- 
ference, but  they  differ  in  their  essentials — they  exclude  each  other 
mutually,  and  contradict  each  other  reciprocally. 


§V.    Gee MAN    School. 

Germany  could  not  remain  behind  the  other  countries  in  medical 
inventions.  She  felt  the  need,  also,  of  having  her  own  national  doc- 
trine for  the  nineteenth  century,  stamped  with  colors  truly  Germanic. 
This  was  thoroughly  understood  by  Dr.  Hahnemann ;  consequently 
he  commenced  dreaming,  meditating,  and  experimenting,  but  espe- 
cially dreaming,  until  at  last  a  ray  from  on  high  illuminated  his 
mind ;  the  true  law  of  past,  present,  and  future  cures  appeared  to  him 
like  a  revelation,  as  a  pure  action  of  divine  love.  Great  physicians  of 
antiquity  and  of  modern  times,  whose  collective  works  of  thirty  centu- 
ries have  served  to  raise  the  scientific  monument  of  the  Healing  Art — 
illustrious  men,  living  and  dead,  bow  before  this  medical  messiah  !  Your 
lights  were  but  darkness,  your  teachings  pure  deception,  your  practice 
a  series  of  blunders  and  homicides  ! 

The  same  would  be  the  case  yet,  if  the  pious,  the  modest  Hahnemann 
had  kept  to  himself  his  great  discovery.  But  he  did  not  wish  to  deprive 
his  fellow  men  of  such  immense  blessings  ;  he  hastened  to  propagate  it 
every  where;  and  if  the  entire  human  species  does  not  enjoy  these  bless- 
ings to-day,  it  is  not  from  want  of  good  will  on  his  part. 

Do  not  imagine,  dear  reader,  that  I  am  jesting,  or  exaggerating  the 
mistico-emphatic  language  of  the  German  thaumaturge,  in  order  to 
render  him  ridiculous.  Hear  him  speak,  himself.  After  having 
recounted  how  he  had  succeeded  in  finding  the  only  true  way  of 
obtaining  veritable,  easy,  prompt,  and  certain  cures,  he  exclaims:  "  For 
truth  is  eternal,  like  divinity  itself.  Man  may  neglect  it  for  a  long. 
time,  but  the  moment  comes  at  last  when,  in  the  fulfillment  of  the 
decrees  of  Providence,  its  rays  pierce  the  cloud  of  prejudices,  and 
throw  over  mankind  a  beneficent  light,  which  henceforth  nothing  can 
extinguish."* 


'  Hahnemann.     Organon.     Paris,  1845. 


608  APPENDIX. 

"  If  I  did  not  know  that  I  am  placed  in  this  world  in  order  to 
improve  myself  as  much  as  possible,  and  to  do  to  others  all  the  good  of 
which  I  am  capable,  I  should  consider  myself  very  foolish  in  making 
the  public  acquainted,  before  my  death,  with  an  Art  of  Healing  which 
I  alone  possess,  and  whose  advantages  I  might  consequently  have 
enjoyed  alone,  by  concealing  this  Art."" 

The  inventor  of  Homeopathy  and  infinitisimal  doses  might  have  been 
asked — If  you  had  kept  your  secret  until  you  descended  into  the  grave, 
who  could  guarantee  you  that  it  would  not  have  been  buried  with  you  ? 
And  even  if  it  should  not  have  fallen  into  oblivion  after  your  death, 
you  would  not  have  enjoyed  during  your  life  such  notoriety ;  you  would 
have  passed  away  in  some  obscure  corner  of  the  world,  and  your  exit 
would  not  have  caused  the  least  sensation.  You  had  therefore  a  great 
and  immediate  interest  in  divulging  as  early  as  possible  your  discovery, 
independently  of  the  satisfaction  which  every  man,  every  Christian 
must  feel  in  fulfilling  a  duty  toward  humanity.  For  nothing  equals,  if 
we  believe  you,  the  frightful  evils  which  were  inflicted  upon  mankind  by 
former  Medicine  —  this  fatal  Art,  as  you  call  it,  which  for  centuries 
has  enjoyed  the  power  to  decide,  arbitrarily,  on  life  and  death,  which 
destroys  ten  times  more  than  do  the  most  murderous  wars,  and  which 
makes  millions  of  others  infinitely  greater  sufferers  than  they  were  at 
first.! 


§VI.     Conclusion. 

I  will  limit  here  my  citations.  I  believe  that  I  have  superabundantly 
proved  what  I  said  at  the  commencement  of  this  letter,  that  there  exist 
no  more  violent  detractors  of  Medicine  than  physicians  themselves. 
Can  we  be  astonished,  after  this,  that  we  find  among  them  so  many  who 
are  incredulous,  so  many  sceptics,  who  exercise  their  Art  without  hav- 
ing faith  in  it  ?  But  I  know  of  no  more  revolting  position  for  a  con- 
scientious man,  nor  a  more  ridiculous  one,  than  that  of  a  physician  who 
has  no  confidence  in  the  means  he  employs.  Such  a  man  can  not  possi- 
bly pursue  the  study  and  the  practice  of  his  Art  with  the  zeal,  applica- 
tion, and  assiduity  which  alone  can  secure  him  real,  honest  success. 
For,  in  order  to  study  and  practice  Medicine  well,  says  a  wise  man  of 
our  time,  we  must  give  it  great  importance,  and  to  be  able  to  do  this, 
we  must  believe  in  it.J 


*■'  Hahnemauu.     Traite  des  Maladies  Chroniques. 

f  Organon. 

I  Cabanis.     Du  degrc  de  Certitude  de  la  Medicine. 


J 


FIRST   LETTER. 


609 


It  is  therefore  essentially  necessary  that  the  physician,  as  well  as  the 
public,  have  a  reasonable  opinion  on  the  degree  of  confidence  which  may 
be  placed  in  Medicine.  But  where  shall  we  find  motives  of  conviction 
in  favor  of  this  science,  when  its  most  renowned  masters  are  so  bold  and 
so  loud  in  discrediting  it  ?  When  every  new  medical  generation  accuses 
all  preceding  ones  of  gross  and  fatal  errors  ?  Who  can  assure  us  that 
the  teachings  of  to-day  will  not  be  treated  as  vain  deceptions  to-mor- 
row, in  a  few  years,  or  a  century  hence  ?  Is  there  in  this  matter  any 
certain  sign,  any  criterion  by  means  of  which  we  may  infallibly  discern 
the  true  from  the  false,  the  certain  from  the  mere  hypothetical  ?  This 
we  shall  examine  in  our  next  letter. 


610  APPENDIX. 


SECOND   LETTER 


IS   THERE    IN    MEDICINE    ANY    MEANS    OF    DISCERNING    THE    TRUE     FROM    THE 
FALSE,  THE  CERTAIN   FROM  THE   HYPOTHETICAL? 


§1.   Importance   of   this   Question. 

It  wants  only  one  moment's  reflection  to  be  convinced  of  the  extreme 
importance  of  such  a  question,  upon  whose  solution  depends,  if  I  do  not 
deceive  myself,  the  whole  future  of  the  science.  Indeed,  if  there  exists 
a  criterion  by  the  aid  of  which  we  can  surely  recognize  truth  in  Medicine, 
if  this  criterion  is  within  reach  of  every  mind,  and  is  applicable  to 
every  part  of  medical  science,  then  we  understand  at  once  that  this 
science  is  possible,  and  those  who  devote  themselves  to  its  erection  may 
hope  not  to  work  in  vain. 

But  if  such  a  criterion  does  not  exist,  or  has  not  been  found,  this 
science  is  impossible ;  then  all  our  knowledge  of  medicine  is  conjecture, 
hypothesis,  and  opinions,  more  or  less  probable.  It  is,  therefore,  of  the 
very  greatest  importance,  before  we  lay  the  foundation  of  the  scientific 
monument  of  Medicine,  that  we  examine  if  we  possess  a  rule,  a  fixed 
standard,  accepted  by  all,  by  means  of  which  we  may  judge  with 
certainty  the  value  of  the  facts  and  ideas  which  shall  in  future  consti- 
tute this  monument. 

As  a  skillful  architect,  before  he  proceeds  to  the  construction  of  an 
edifice,  reduces  all  his  measures,  and  all  his  calculations  to  a  known 
and  invariable  quantity,  called  unit,  so  also  must  physicians  choose  a 
fixed,  uniform,  and  sure  criterion,  in  order  to  estimate  the  degree  of 
certainty,  adaptation,  and  utility,  of  the  different  propositions  which 
form  the  materials  of  their  science.  Without  this  precaution  they  will 
never  be  able  to  agree  upon  any  subject.  Their  discussions  will  con- 
tinually degenerate  into  mere  verbiage,  as  has  been  the  case  too  frequently, 
until  now,  and  they  will  continue  to  offer  to  the  world  a  ridiculous 
spectacle,  like  individuals  who,  desirous  of  appreciating  a  common  object, 
as  for  example,  the  hight  of  a  steeple,  or  of  a  mountain,  still  persist,  each 
one  according  to  his  own  caprice,  in  taking  a  different  standard  as  unit, 
bearing  no  relation  whatever  to  the  other  measures.  Such  surveyors 
would  most  certainly  never  arrive  at  identical  or  even  comparable  results. 


SECOND  LETTER.  611 

It  is,  therefore,  essentially  necessary,  if  we  wish  to  put  an  end  to  this 
continued  and  profound  conflict  of  medical  opinions  —  a  conflict  so 
injurious  to  the  progress  of  science,  and  to  the  standing  of  those  who 
cultivate  it  —  it  is  necessary,  I  say,  to  choose  a  mode  of  appreciation  which 
belongs  to  all  times,  and  all  places,  embracing  all  facts,  and  all  ideas, 
that  compose,  or  may  yet  compose,  the  science  of  Medicine  ;  which  will 
bring  them  all  back  to  a  unique,  universal,  invariable  standard,  known 
and  accepted  by  all.  Now,  in  order  to  find  such  a  mode  of  appreciation, 
which  is  perfectly  appropriate  to  medical  researches,  we  must  know  their 
final  aim — just  as  a  traveller  must  have  fixed  the  point  which  he  desires 
to  reach,  before  he  decides  which  route  to  take,  without  which  he  travels 
at  hazard,  like  a  fool. 

Let  us  examine,  therefore,  first  of  all,  what  is  the  final  aim  of  the 
science  of  Medicine. 


§^11.   Final   Aim   of   Medical   Science. 

In  the  primitive  ages  Medicine  was  defined  to  be  the  Art  of  Healing  ; 
at  that  time  therapeutics  was  evidently  the  final  aim  of  that  science. 
Later,  when  the  field  of  observation  had  been  widened,  it  was  seen  that 
it  was  often  much  easier,  and  always  more  advantageous,  to  prevent 
diseases,  than  to  combat  them  after  they  were  developed.  Consequently, 
the  tree  of  medical  science  brought  forth  another  branch,  called  hygiene, 
or  prophylaxy,  whose  special  object  consists  in  preserving  health,  or 
preventing  the  development  of  diseases.  Properly  speaking,  this  new 
branch  is  an  offspring  of  therapeutics,  and  was  so  considered  by  many 
ancient  as  well  as  modern  authors,  and  thus  this  science  has  not 
changed  its  aim  by  this  accession,  but  has  been  enlarged  and  extended 
by  it. 

For  some  time  past.  Medicine  has  occupied  itself  in  a  more  eflacacious 
manner,  with  two  very  important  orders  of  morbid  affections,  which 
formerly  were  entirely  overlooked,  or  at  least  much  neglected — I  allude 
to  the  deformities  which  are  the  objects  of  orthopedia,  and  mental 
affections,  which  constitute  at  this  time  one  of  our  most  interesting 
specialities.  In  view  of  these  additions.  Medicine  can  now  be  defined : 
a  science  whose  object  is  the  preservation  of  health,  the  cure  of  diseases, 
and  the  physical  perfection  of  man.  Eemark,  I  beseech  you,  that  in 
these  successive  evolutions  the  aim  of  the  science  does  not  change,  and 
it  never  leaves  the  sphere  of  therapeutics.  Therefore,  it  may  be  said 
for  all  epochs  with  equal  truth  : 

Ars  medica  est  id  quod  est  propter  therapeuLicen. 
Everything  in  Medicine  is  related,  or  should  relate,  to  therapeutics. 


612  APPENDIX. 


§  ni.  Answer  to  the  Question  placed  at  the  Head  of  this  Lettee. 

Now,  as  the  aim  of  the  science  of  Medicine  is  fully  known  to  us, 
nothing  is  easier  than  to  determine  the  route  which  leads  us  to  it,  or,  in 
other  words,  than  to  find  a  sure  method  for  the  discovery  and  the  founda- 
tion of  truth  in  Medicine.  We  can,  from  this  moment,  establish  the 
following  general  proposition :  Every  notion,  every  idea,  every  hypothesis, 
every  system,  which  is  useless  to  therapeutics,  must  be  banished  from 
Medicine,  as  useless  and  superfluous ;  every  notion,  every  idea,  every 
hypothesis,  every  system,  which  leads  to  false  or  hurtful  conseq^uences 
in  therapeutics,  must  be  rejected  as  tainted  with  error. 

Then,  if  we  ask  by  what  means,  in  what  way,  we  can  assure  ourselves 
that  any  doctrine  is  either  advantageous,  or  barren,  or  prejudicial  to 
therapeutics,  I  acknowledge  that  I  know  of  none  better,  or  more  direct, 
than  experience.  Thus,  in  my  eyes,  the  universal  criterion  of  truth  in 
Medicine,  the  supreme  test  of  the  value  of  all  ideas  and  discoveries 
which  belong  to  this  science,  is  none  other  than  therapeutical  proof  .  It 
seems  to  me  that  I  see  the  reader  smile  at  this  word,  and  hear  him  say : 
This  is  certainly  no  new  maxim  I  There  is  no  one  who  does  not  agree 
that  therapeutical  proof  is  the  best  and  surest  mode  of  verification  which 
we  possess  in  Medicine — the  ultima  ratio  of  all  medical  doctrine. 
Every  day  the  founders  of  new  systems  appeal,  themselves,  to  this  defini- 
tive tribunal.  But  this  does  not  prevent  and  never  has  prevented  the 
most  absurd  theories,  the  most  ridiculous  errors,  from  invading  the 
domain  of  this  science ;  and  there  reigns  to-day  still  the  most  complete 
want  of  harmony  among  physicians  upon  the  most  fundamental  ques- 
tions of  the  Art.  This  objection,  therefore,  is  serious,  and  should  be 
closer  examined  ;  but  I  do  not  believe  it  insoluble,  and  I  will  endeavor 
to  reply  to  it.  It  is  not  sufficient  to  proclaim  in  a  vague  and  general 
manner  that  therapeutical  proof  is  the  best  criterion  in  medicine  ;  it  is 
also  necessary  to  know  how  to  make  a  rational  and  methodical  use  of 
this  universally  admitted  criterion ;  just  as  it  does  not  suffice  to  possess 
an  excellent  musical  instrument  in  order  to  obtain  pure  and  harmonious 
sounds ;  but  we  must  also  understand  a  good  method  of  playing,  and 
have  practised  on  it. 

Now,  I  ask,  does  there  at  this  time  exist  in  our  science  a  general  sys- 
tem of  therapeutics, — a  system  which  embraces  as  a  whole,  logically 
arranged,  all  plans  of  treatment  ?  Is  it  not,  on  the  contrary,  an  opinion 
universally  accredited  in  all  the  schools,  that  the  time  has  not  come  yet 
for  a  rational  systematizing  of  this  branch  of  Medicine  ?  You  have 
read  in  my  First  Letter  (§1)  what  some  of  our  cotcmporaries  think 


SECOND  LETTER.  613 

upon  this  subject.  You  may  appeal  to  any  otlier  of  our  modern  classics — 
you  will  not  find  in  one  of  them  a  different  opinion.  All  agree  in 
admitting  rational  and  irrational  modes  of  medication,  which  latter 
they  call  also  empirical.  But  what  is  oddest  in  this  classification,  is 
that  the  modes  of  medication  called  irrational  are  generally  the  most 
efficacious. 

It  is  therefore  a  new  idea,  which  possesses  at  least  the  merit  of  origi- 
nality, to  try  to  construct  logically  the  entire  field  of  therapeutics — to 
unite  in  one  plan  and  under  the  guidance  of  a  unique  principle  all 
modes  of  internal  and  external  medication,  without  regard  to  any 
pathological  system.  Such  an  idea  must  appear  certainly  very  paradoxi- 
cal to  those  who  profess  with  M.  Bouillaud  that  "  therapeutics  is  neces- 
sarily but  a  deduction,  a  corollary  from  the  ideas  which  are  formed  on 
the  nature  of  diseases,"  and  that  it  cannot  be  anything  else. 


§  IV.    Inquiry  after  the  FuxDAiiENTAL  and   Uktveesal  Principle   of   Thera- 
peutics. 

If  the  question  were  asked,  what  has  taught  men  to  provide  for  the 
indispensable  things  of  life,  to  prepare  their  food  and  clothing,  to  con- 
struct habitations  to  shelter  them  against  the  rigor  of  the  seasons,  etc.  etc., 
no  one  would  be  at  loss  for  an  answer.  It  is  want,  necessity,  the  instinct 
of  self  preservation.  If  we  now  ask,  what  has  inspired  these  same  men 
with  aversion  to  pain,  the  fear  of  disease  and  death,  the  desire  to  defend 
not  only  themselves  but  also  those  who  are  dear  to  them,  against  these 
afflictions  ?  we  can  answer  with  the  same  assurance  :  It  is  a  natural, 
irresistible  instinct,  which  is  felt  alike  by  the  savage  on  the  desert  and 
the  inhabitant  of  the  city,  by  the  poor  and  the  rich,  by  the  philosophic 
and  the  illiterate. 

Xow,  experience  early  taught  the  inhabitants  of  the  earth  that  nature 
alone  is  insufficient  to  aid  them,  in  many  instances.  As  for  example,  an 
individual  breaks  a  limb:  nature  is  incapable  of  bringing  and  keeping 
together  the  two  ends  of  the  broken  bone.  Another  dislocates  an  arm 
or  a  leg.  If  he  expects  from  nature  the  reparation  of  this  accident,  he 
will  be  deprived  for  his  whole  life  of  the  full  use  of  his  limb.  A  third 
ruptures  a  large  vein  or  an  artery ;  nature,  powerless  in  this  case,  will 
suffer  this  individual,  full  of  health  and  life,  to  succumb  from  the  loss 
of  his  blood.  Let  a  woman  in  labor  be  seized  with  couvulsioiis  or  vio- 
lent hemorrhage,  or  let  her  child  present  itself  in  an  unfavorable  posi- 
tion, and  what  will  mother  nature  do  in  presence  of  such  accidents  ? 
Nothing.       She   will   allow   both  victims    to  perish.      In   fine,  there 


614  APPENDIX. 

happen  every  day  in  the  natural  course  of  life,  a  number  of  accidents 
which  nature  alone  is  incapable  of  repairing.  Hence  men  very  early 
acquired  the  conviction  that  they  could  only  expect  aid  from  Providence 
when  trying  to  aid  themselves  by  every  means  at  their  command.  Con- 
sequently, as  soon  as  one  of  them  received  a  wound  or  was  attacked  by  a 
disease,  those  who  had  witnessed  similar  cases  were  invited  to  see  it,  that 
they  might  indicate  the  remedies  which  they  had  seen  employed  in  simi- 
lar cases.  Soon  there  were  found  men,  especially  old  men,  who  distin- 
guished themselves  by  their  skill  and  experience  in  these  kinds  of  acci- 
dents, and  who  transmitted  to  others  the  fruits  of  their  observations. 
Such  was,  among  many  nations,  the  origin  of  medical  science,  as  is 
attested  by  tradition  and  authentic  monuments."  Afterward,  the  art  of 
writing  having  been  invented,  it  became  possible,  with  the  aid  of  this 
admirable  art,  to  preserve  indefinitely  the  remembrance  of  diseases,  and 
the  means  used  for  their  cure.  Henceforth  they  began  to  form  nosologi- 
cal collections,  i.  c.  collections  containing  more  or  less  detailed  descrip- 
tions of  the  morbid  affections  which  were  observed,  and  of  the  treat- 
ment which  was  employed  against  them.  These  collections  became  the 
first  codes  of  the  Healing  Art,  and  the  men  who  devoted  themselves 
especially  to  the  care  of  the  sick  studied  them  no  doubt  as  rules  for 
their  conduct.  Gradually  these  collections  were  enlarged  by  successive 
additions  of  new  observations ;  so  that  When  they  had  attained  a  con- 
siderable volume,  it  became  necessary  to  arrange  the  materials  of  which 
they  were  formed,  in  a  certain  order,  which  made  it  easy  to  find  at 
pleasure  the  instructions  that  were  wanted.  This  was  the  origin  of 
pathological  classifications.  The  idea  of  it  was  suggested  by  the  desire 
to  aid  the  memory  and  facilitate  researches. 

At  that  epoch  very  little  was  done  in  the  study  of  the  intimate 
nature  of  diseases  and  the  physiological  action  of  medicaments.  They 
were  satisfied  to  observe  and  to  describe  the  morbid  phenomena  as 
they  showed  themselves,  and  to  note  the  apparent  effects  of  the  remedies. 
And  this  is  done  yet  by  all  persons  ignorant  of  the  science  of  Medicine, 
when  they  undertake  to  give  their  advice  to  the  sick.  These  persons 
have  no  other  way  of  expressing  themselves  than  the  following :  I  have 
seen  precisely  the  same  disease  cured  by  such  or  such  remedy. 

At  first  sight  the  medical  practice  of  those  primitive  times  seems  to 
us  gross  and  scarcely  reasonal)le ;  but  when  we  consider  it  nearer — when 
we  examine  with  unprejudiced  eyes  the  motives  which  directed  it,  we 
find  that,  far  from  being  unreasonable,  this  practice  was  based  upon  a 
principle  of  incontestible  evidence,  which  may  be  stated  in  the  following 

^  Primitive  Period ;  Medicine  among  the  Egyptians. 


SECOND   LETTER.  615 

words:  Every  kind  of  medication  tvhich  has  cured  one  disease 
must  also  cure  analogous  diseases.  No  objection  can  be  made  to  this 
principle.  It  possesses  all  the  clearness  and  infallibility  of  a  mathe- 
matical problem ;  it  corresponds  with  the  following  metaphysical  axiom : 
The  same  cause,  the  same  force  or  the  same  combination  of  forces,  acting 
in  identical  conditions,  will  always  produce  the  same  effect. 

We  see  also  by  a  little  reflection,  that  the  above  announced  principle 
embraces  all  the  operations  of  internal  and  external  Medicine,  as  well 
as  all  the  precepts  of  prophylaxy.  Thus  there  has  existed  at  all  times 
a  fundamental  and  universal  principle  for  the  practice  of  Medicine ;  a 
principle  by  which  the  physicians  of  the  most  remote  times  were  guided 
without  knowing  it,  and  which  is  followed  yet,  though  ignorantly,  by 
all  persons  without  medical  knowledge,  when  they  undertake  to  give 
advice  to  the  sick. 

But  if  it  may  be  permitted,  as  Moliere  says,  to  write  prose  without 
knowiug  it,  it  is  still  better  to  do  so  knowingly,  because  it  is  then  done 
much  better.  So  if  there  are  now  persons  who  employ  this  fundamental 
principle  of  therapeutics  without  understanding  it,  it  is  still  better  to 
employ  it  understandingly.  This  is,  besides,  more  worthy  of  a  practi- 
tioner who  loves  to  understand  the  motives  of  his  conduct,  and  it  is  also 
more  satisfactory  for  the  patient.  Let  us  see,  therefore,  how  we  can 
make  a  logical  application  of  the  above  proclaimed  principle. 


§  V.     Ratioxal  Application  of  the  Universal  Axiom  of  Therapeutics. 

I  have  said  it  was  a  new  idea  to  try  to  bring  therapeutics  under  the 
dominion  of  a  single  principle,  disconnected  from  all  pathological  sys- 
tems. This  is  true  only  in  regard  to  modern  times,  for  there  existed  in 
antiquity  a  sect  of  medical  philosophers  who  conceived  the  same  project 
and  attempted  its  execution.  But  their  doctrine  did  not  prevail, 
because  they  did  not  develop  it  fully,  or  did  not  defend  it  well,  or  it 
may  be  that  their  cotemporaries  did  not  understand  and  appreciate  it. 
At  all  events,  their  labors  and  their  system  have  been  almost  completely 
lost,  and  their  name  has  in  many  instances  become  a  word  of  reproach.  ="- 

In  reflecting  a  little  upon  this  axiom,  Each  remedy  ivhich  has  cured 
one  disease,  must  also  cure  analogous  diseases,  we  can  not  fail  to  perceive 
that  its  practical  application  depends  upon  three  conditions,  viz :  the 
homogeneousness  of  the  diseases,  identity  of  the  curative  means,  and 
knowledge  of  the  best  possible  treatment  for  every  morbid  species.     Let 


■  See  Philosophic  Period. 


616  *  APPENDIX. 

US  see,  therefore,  how  we  can  fullfil  these  three  conditions,  if  not  in  a 
perfectly  exact  manner,  at  least  proximately. 

riK3T  CONDITION.  —  H  O  M  O  O  E  N  E  O  U  S  N  E  S  8  OP  DISEASES. 

No  practitioner  during  his  whole  life  has  ever  met  two  identical  mor- 
bid cases,  and  nature  perhaps  never  produces  them  exactly  alike.  We 
must  therefore  be  contented  with  a  greater  or  less  similarity.  But  on 
what  degree  of  approximation  must  the  physician  rest,  or,  in  other 
words,  in  what  symptoms  will  he  recognize  similitude  enough  iu  two 
diseases,  one  of  which  is  under  his  eye  and  the  other  has  been  observed 
formerly,  in  order  to  treat  the  second  by  the  same  remedies  as  the  first  ? 

We  are  touching  here  the  most  knotty  question  in  pathology,  the 
question  which  has  been  the  object  of  the  most  assiduous  researches 
and  the  most  profound  meditations,  the  question  which  has  excited  the 
most  discussions,  given  birth  to  the  greatest  number  of  systems,  and 
engendered  the  most  errors  :  W/taf  are  the  characteristic  signs  of  the 
homogeneonsness  of  diseases^  Interrogate  the  physicians  of  all  sects 
and  of  all  times  upon  this  subject,  and  they  will  all  give  you  different 
and  even  contradictory  answers. 

In  the  beginning,  they  were  satisfied  with  a  mere  superficial  resem- 
blance ;  it  sufficed  that  a  patient  presented  one  or  two  symptoms  similar 
to  those  which  had  been  observed  in  another,  to  authorize  the  applica- 
tion of  the  same  treatment.  It  is  upon  this  same  gross  appearance  that 
quacks  and  charlatans  judge  yet,  daily,  of  the  similarity  of  diseases,  on 
which  they  advise  certain  kinds  of  medication.  Let  a  child,  for  exam- 
ple, be  attacked  with  a  slight  impetigo  of  the  face  or  head,  and  a  quack 
(pharmacopole)  will  not  fail  to  prescribe  bitters,  depuratives,  and  setons, 
without  even  examining  the  state  of  the  digestive  organs  or  the  nervous 
susceptibility  of  the  little  patient.  Let  an  old  man  cough  up  some 
mucus,  and  at  once  they  administer  a  variety  of  cough  mixtures. 

Men  accustomed  to  the  observation  of  diseases  dare  not  prescribe 
remedies  so  thoughtlessly.  They  know  how  faulty  and  dangerous  is 
this  manner  of  diagnosticating  and  determining  a  pathological  state. 
"  I  have  always  felt  it  acutely,"  says  Pinel,  "and  I  feel  it  yet  daily, 
how  important  it  is  for  us  to  cultivate,  after  the  example  of  naturalists, 
the  science  of  signs,  to  become  accustomed  to  understand  well  the  exter- 
nal characteristics  of  diseases,  and  to  be  constantly  guarded  against 
illusion  and  errors  in  difficult  cases." 

"  Notwithstanding  the  immortal  works  of  Morgagni,"  says  M.  Bouil- 
laud,  "notwithstanding  the  anatomo-pathological  impulse  which  Bichat 
and  his  school  had  given  to  Medicine,  and  which  Pinel  has  the  credit  of 
following  in  several  parts  of  his  nosography,  notwithstanding  all  this, 


SECOND   LETTER.  617 

the  time  had  not  yet  come  when  diseases  were,  so  to  say,  personified,  by 
attaching  them  to  the  organs ;  in  a  word,  localizing  them.  This  great 
era,  for  which  preparations  had  long  been  made,  shone  only  in  all  its 
splendor  at  the  epoch  when  the  author  of  Chronic  Phlegmasia  took  the 
scepter  of  Medicine,  which  the  old  I'inel  had  borne  so  long  with  honor, 
but  whose  weight  he  could  no  longer  bear.  This  new  era  dates  from 
the  year  1816,  when  appeared  the  famous  Examen  dela  doctrine  Medi- 
cate genrralement  adoptee,  with  the  following  epigraph,  taken  from 
Bichat :  What  is  observation  ivorth,  if  we  are  ignorant  of  the  seat  of  the 
disease  ? 

Thus  the  nosological  formula  of  Pinel  which  had,  at  the  commence- 
ment of  the  nineteenth  century  appeared  to  be  so  exact,  is  judged  as 
insufficient  by  Broussais  but  a  few  years  later ;  and  the  formula  of 
Broussais,  so  highly  praised  by  M.  Bouillaud,  appears  to-day  as  incom- 
plete in  many  instances,  so  true  is  it,  that  the  diagnosis  of  diseases 
changes  in  proportion  to  the  progress  of  science,  and  offers  at  all  times 
difficulties  which  the  vulgar  do  not  even  suspect. 

It  is  frightful  what  immense  and  minute  details  M.  Louis  demands 
for  the  true  appreciation  of  pathological  facts  ;  still,  after  serious  reflec- 
tion, we  are  obliged  to  agree  with  him  that  these  details  are  necessary  in 
researches  after  truth. 

Here  is  the  abridged  table  of  the  principal  characteristics  which  con- 
stitute to-day  the  diagnosis  of  diseases,  and  by  which  we  are  able  to 
discern  the  different  morbid  species,  or  the  homogeneousness  of  each,  of 
them :  First,  the  circumstances  anterior  to  the  invasion  of  the  disease, 
which  comprise  the  predispositions  or  diathesis,  the  occasional  or  deter- 
mining causes,  contagious  infections,  etc. ;  "  second,  the  anatomical  seat 
of  the  disease,  i.  e.,  the  designation  of  the  organ  or  tissue  principally 
affected,  and  sometimes  the  indication  of  a  vitiated  humor ;  third,  the 
mode  and  degree  of  alteration  of  the  organs ;  fourth,  the  idiopathic  and 
sympathetic  functional  derangements,  their  regular  or  irregular,  contin- 
ued or  intermitting  course  ;  finally,  the  cadaveric  lesions  found  in  those 
who  have  succumbed  to  the  same  morbid  species. 

We  see  by  this  enumeration  of  the  principal  objects  which  constitut-e 
the  diagnosis  of  a  disease,  that  in  order  to  be  able  to  fulfill  this  condi- 
tion well,  we  must  unite  to  a  most  precise  knowledge  of  nosography 
and  pathology,  the  lights  of  anatomy,  physiology,  chemical  analysis, 
pathological  anatomy,  etc.,  etc. 

This  immense  difficulty  of  diagnosis  is,  without  contradiction,  one  of 


"  Memoire  sur  I'Examcn  des  Malades  et  la  Recherche  des  Faits  generaux,  by 
M.  Louis.    Paris,  1846. 

39 


618  APPENDIX. 

the  greatest  obstacles  whicli  we  meet  with  in  the  study  and  practice  of 
Medicine.  There  are  no  systems,  no  combinations  which  pathologists 
have  not  imagined,  with  the  view  of  overcoming  or  facilitating  it.  All 
have  endeavored  to  unite  the  infinite  number  of  varieties  of  diseases 
into  a  small  number  of  types,  distinguished  from  each  other  by  appre- 
ciable characteristics. 

Hahnemann  alone,  wishing  to  spare  himself  and  his  disciples  the  labors 
of  diagnosis,  has  given  the  singular  precept  to  note  one  after  another, 
without  choice,  without  discernment,  in  the  mere  order  in  which  they 
make  their  appearance,  all  the  symptoms  observed  during  the  course  of 
a  disease,  either  by  the  patient  himself  or  the  physician.  But  this 
method,  apparently  so  natural  and  exact,  is  in  reality  extremely  defec- 
tive and  even  impracticable,  as  will  be  evident  by  the  following  table : 

First,  Such  a  method  is  extremely  defective,  for  it  makes  the  capital 
error  of  ascribing  the  same  value  to  all  morbid  phenomena,  while  there 
exist  immense  diiFcrences  among  them,  as  the  most  superficial  clinical 
•observation  proves.  What  shall  we  think  of  a  pathologist  who  considers 
as  signs  of  the  same  disease,  and  as  possessing  equal  value,  the  follow- 
ing symptoms : 

Insatiable  thirst, 

Palor  of  face, 

Scrofula, 

Sweating  of  the  head  after  sleep. 

Burning  in  the  palms  of  the  hands, 

Frequent  attacks  of  suffocation, 

Furuncles, 

Vomiting  of  blood. 

Hiccough  after  eating  or  drinking, 

Cutting  pain  in  the  rectum  while  at  stools, 

Absence  of  venereal  desires, 

Unbridled  lusts. 

Somnolency  during  the  day,  after  meals, 

Paroxysms  of  anger  bordering  on  mental  alienation. 

Tears,  frequently,  at  the  slightest  causes,  etc.,  etc." 

Thousands  of  phenomena,  thus  thrown  together  without  order,  consti- 
tute no  more  clinical  observation,  and  give  no  better  idea  of  a  disease, 
than  a  number  of  stones  piled  up  without  plan  constitute  the  Pantheon, 
or  than  lines  drawn  capriciously  on  paper  present  the  image  of  a  regular 
monument.  This  is  certainly  no  method  at  all ;  it  is  the  absence,  the 
negation  of  all  method  in  pathology.     It  is  chaos. 

''  See  Treatise  of  Chronic  Diseases  by  this  author. 


SECOND  LETTER,  gJQ 

Second,  a  peremptory  motive  opposes  the  adoption  of  such  a  proceed- 
ing. This  motive  consists,  as  we  have  said  above,  in  the  impossibility 
of  its  being  put  into  execution.  Indeed,  let  one  try  to  note  down  all 
the  slight  and  grave,  passing  and  permanent  accidents  which  arise  in 
the  course  of  a  morbid  affection,  and  take  account  of  all  the  chano-es, 
all  the  impressions,  moral  as  well  as  physical,  which  the  patient  experi- 
ences every  day,  every  hour,  yea,  every  minute.  It  would  be  just  as 
reasonable  to  try  to  count  all  the  grains  of  sand  driven  before  a  storm, 
or  the  atoms  which  a  ray  of  light  falling  into  a  dark  room,  causes  to 
glitter  in  the  air.  Both  the  undertakings  are  equally  impracticable  and 
futile. 

We  are  therefore  led  by  the  natui^  connection  of  ideas,  and  the  ir- 
resistible force  of  things,  to  make  a  choice  among  the  symptoms 
which  present  themselves  in  the  course  of  a  disease.  We  are  obliged 
to  ask  ourselves  the  question  :  which  are  among  the  pathological  symp- 
toms, those  which  are  of  greatest  importance,  those  which  are  less  grave, 
and  those  which  are  of  so  little  value  that  they  may  without  inconven- 
ience, be  entirely  overlooked  ? 

SECOND     CONDITION.  —  IDENTITY     OP     CURATIVE     MEANS. 

Hygiene  and  materia  medica  being  the  two  sources  from  which  Medi- 
cine draws  its  means  for  combatting  disease,  it  is  evident  that  the  prac- 
titioner must  be  fully  acquainted  with  the  resources  which  these  sci- 
ences offer  him.  Xow,  hygiene  receives  its  light  principally  from  physics, 
chemistry,  etc.;  materia  medica  cannot  be  understood  without  a  knowl- 
edge of  pharmacology,  natural  history,  etc.  Thus  the  practitioner  dare 
not  remain  a  stranger  to  any  of  these  branches  of  human  knowledge,  in 
order  that  he  may  be  able  to  choose,  prepare  and  superintend  the  use  of 
curative  agents  with  the  greatest  possible  discernment  and  exactness. 
It  is  furthermore  indispensable  that  he  obtain  on  the  part  of  the  patient 
himself,  entire  obedience,  and  faithfulness  on  the  part  of  the  attendants. 

THIRD    CONDITION.  —  KXOWLED&E    OP     THE    BEST     POSSIBLE     TREATMENT    OF 
EVERY     MORBID    SPECIES. 

The  aptitude  to  fulfil  this  last  condition,  that  is,  to  discern  the  treat- 
ment best  adapted  to  each  pathological  case,  constitutes  alone  the  true 
practitioner.  This  distinguishes  him  from  the  mere  erudite ;  it  forms 
the  cap  stone  of  all  medical  education.  But  nothing  is  more  rarely 
found  than  such  an  aptitude  ;  and  nothing  is  more  difficult  to  acquire. 
It  can  only  be  attained  by  combining  the  scientific  knowledge  of  the 
century,  with  a  large  practice,  directed  by  a  wise  method,  and  con- 
ducted by  a  sincere  desire  to  be  useful  to  his  fellow  man,  and  by  a  rea. 
sonable  faith  in  the  eflBcacy  of  the  Art. 


620  APPENDIX. 

It  is  a  truth  proclaimed  by  all  the  masters  of  science,  that  it  does  not 
suifice  to  see  a  great  number  of  patients,  in  order  to  become  a  good  medi- 
cal practitioner ;  but  that  it  is  also  necessary  to  examine  every  case 
with  a  care  and  a  zeal  which  cannot  be  sliaken  by  the  fatigue  or  disgust 
to  which  the  practice  of  Medicine  is  subject.  Now,  he  alone  is  able  to 
overcome  such  obstacles,  who  devotes  himself  to  the  study  as  well  as  to 
the  practice  of  his  Art,  with  a  real  love  for  mankind,  and  a  reasonable 
confidence  in  the  means  he  employs.  Even  popular  instinct  knows  very 
well  how  to  distinguish  the  practitioner  who  observes  his  patients  with 
attention  and  interest,  from  him  who  scarcely  examines  them  at  all,  lis- 
tens to  them  inattentively,  and  prescribes  for  them  with  indiiFerence. 

But  let  us  suppose  a  physician  to  be  provided  with  the  necessary 
knowledge,  and  animated  by  sentiments  worthy  of  his  profession,  what 
method  must  he  follow  to  arrive  at  the  determination  of  the  treatment 
best  adapted  to  each  morbid  species  ? 

We  have  already  said  that  the  first  experimenters  did  not  reason  at 
ail  upon  the  intimate  action  of  remedies,  but  that  they  contented  them- 
selves to  observe  their  most  apparent  efifects,  and  to  note  those  which 
had  cured,  or  seemed  to  have  cured  certain  diseases,  in  order  to  employ 
them  again  in  similar  cases.  The  first  materia  medicas  were  so 
arranged  that  curative  means  were  classed  according  to  their  most 
usual  and  evident  efifects.  Blood  letting  for  example,  must  have 
been  classed  among  the  depletives  of  the  blood  vessels ;  hellebore 
with  the  eccoprotics,  because  it  produces,  generally,  alvine  evacuations : 
opium  with  the  upnotics  or  anodynes,  because  it  often  produces  sleep. 
and  allays  or  cures  pain.  This  classification,  and  these  denominations, 
were  irreproachable,  for  they  were  founded  upon  a  real  and  incontestible 
action  of  the  curative  agents.  Besides,  if  imperfections  or  errors  had 
entered  into  the  first  collections  in  consef[uence  of  superficial  or  too 
hasty  observations,  a  riper,  more  attentive  observation,  would  lead  to 
their  expulsion.  Thus,  for  example,  after  having  classed  opium  with 
the  upnotics,  nothing  forbade  to  add  that  this  substance  sometimes  pro- 
duces agitation  instead  of  sleep  ;  whence  it  follows  that  it  is  to  be  ad- 
ministered with  great  circumspection,  and  only  after  determining  fully 
under  what  circumstances  and  in  what  doses  it  produces  or  augments 
agitation. 

We  see  by  these  examples  that  therapeutics,  which  from  the  begin- 
ning had  been  founded  upon  the  simple  results  of  experience,  should 
have  been  enlarged  and  perfected  by  the  same  method,  that  is,  by  con- 
tinuing to  take  into  account  only  the  pure  results  of  experience,  without 
seeking  to  explain  them.     Such  is,  indeed,  the  method  to  which  Bichat 


SECOND  LETTER.  621 

seems  to  allude  in  the  followiug  sentence :  "  Except  the  medicines  whose 
effects  are  established  by  strict  observation,  such  as  the  evacuants,  diu- 
retics, sicdagogues,  etc.,  and  to  xohat  does  our  knowledge  of  the  rest 
amount  ?  " 

But  there  arrived  a  time  when  tliis  manner  of  studying  the  action  of 
therapeutic  agents  appeared  to  be  too  simple,  too  superficial,  too  much 
subject  to  error.  Physicians  wished  to  penetrate  deeper  into  the  secret 
of  the  modifications  which  eacb  medicament  produces  upon  the  human 
economy.  They  reasoned  thus :  The  sensible  eff"ects  vary  frequently, 
according  to  a  great  number  of  circumstances,  often  difficult  to  appreciate. 
As  these  consecutive  effects  all  depend  upon  the  intimate  molecular  im- 
pressions which  each  therapeutical  substance  exercises  constantly  in  the 
organism,  if  we  can  only  arrive  at  determining  the  nature  of  this  impres- 
sion, we  shall,  by  this  means,  know  the  secondary  efi'ects  which  depend 
upon  them — we  shall  be  able  to  foresee  and  explain  them  logicOjlly. 

This  new  method  was  considered  the  most  rational,  the  shortest  and 
most  direct.  It  prevailed,  at  length,  almost  universally  in  science,  and 
is  yet  followed  by  most  of  our  medical  writers.  Still  it  has  produced 
but  very  unsatisfactory  results,  as  we  can  judge  from  the  great  want  of 
harmony  which  reigns  to  day  upon  this  subject  in  the  profession,  as  I 
have  proved  in  my  First  Letter,  and  which  Bichat  has  painted  in  such 
energetic  colors. 

"  Into  what  errors  in  the  use  and  denomination  of  medicines  have  we 
not  been  lead  "?  When  the  theory  of  obstruction  was  in  vogue,  desobstru- 
ants  were  created.  Incisives  sprang  up  when  the  theory  of  the  thick- 
ening of  the  blood  became  the  favorite  idea.  The  expressions. 
dilutants  and  attenuants,  and  the  ideas  which  were  attached  to  them, 
arose  at  the  same  epoch.  AVhen  it  was  necessary  to  obtund  acridity, 
inviscants,  incrassants,  etc.,  were  created.  Identical  means  have  often 
had  different  names,  according  to  the  manner  in  which  they  were  sup- 
posed to  act — desobstruant  with  one,  relaxant  with  another,  refrigerant 
with  a  third — the  same  medicament  has  been  employed  in  turn,  with 
different  and  even  opposite  views,  so  true  is  it  that  the  human  mind 
marches  at  hazard  where  the  vagueness  of  mere  opinions  guide  it."  =•' 

This  would  be  the  place  to  speak  of  the  therapeutical  methods — that 
is,  of  the  general  plans  of  treatment  which  might  be  formed  in  the  actual 
state  of  science,  independently  of  all  pathological  systems.  But  I  can- 
not treat  at  the  end  of  a  letter,  so  important  a  subject,  upon  which  I 
have  to  say  so  many  things  which  differ  from  the  ideas  received  in  our 

'-  Anatomie  Generale. 


622  APPENDIX. 

schools.  I  shall  reserve  it,  therefore,  for  another  occasion,  when  it  will 
be  possible  for  me  to  ti-eat  it  as  widely  and  as  much  in  detail  as  the 
subject  demands. 


§VI.      COXCLUSIOX. 

We  have  proved  that  in  the  eyes  of  the  learned,  as  well  as  the  ignor- 
ant, those  well  versed  in  the  science  and  practice  of  Medicine,  as  well 
as  in  those  who  are  strangers  to  the  Healing  Art,  the  best  criterion  of 
truth  in  Medicine  is  nothing  else  than  therapeutical  proof ;  conse- 
quently we  have  endeavored  to  establish  this  proof  on  a  fixed,  evident, 
and  incontestible  principle,  not  subject  to  the  vicissitudes  of  pathological 
theories — and  we  have  found  that  this  principle  may  be  expressed  as 
follows :  That  medication  which  has  cured  one  disease,  must  cure 
equally,  all  analogous  diseases.  Whence  is  derived  this  universal  and 
absolute  precept :  Treat  each  disease  by  the  means  whose  efficacy  expe- 
rience has  demonstrated  in  homogeneous  cases. 

Then  we  have  shown  that  the  rational  application  of  this  axiom 
rests  on  three  conditions,  whose  fulfillment  demand  that  the  practitioner 
possess,  with  the  scientific  knowledge  of  his  time,  a  consummate  experi- 
ence— in  other  words,  that  its  rational  application  necessarily  requires 
the  indefinite  developement  of  all  intrinsic,  as  well  as  accessory  branches 
of  medical  science.  Under  the  impulse  of  such  a  principle,  science  has 
grown  from  its  origin,  and  must  continue  to  grow  in  the  future. 

For  this  reason  one  of  our  most  ancient  authors  could  say  with 
deeply  felt  truth :  "  Medicine  has  long  been  in  possession  of  a  principle 
and  a  method,  both  of  which  it  has  found.  AYith  these  guides,  numer- 
ous and  valuable  discoveries  have  been  made  in  the  course  of  centuries, 
and  the  rest  will  be  ascertained  when  capable  men,  acquainted  with  the 
discoveries  of  the  ancients,  take  these  as  a  starting  point  for  their 
researches.  But  he  who,  rejecting  and  disdaining  the  past,  attempts 
other  methods  and  other  paths,  and  then  pretends  to  have  found  some- 
thing, deceives  himself,  and  will  deceive  others."  ■■■' 

These  prophetic  words  have  not  prevented  a  great  number  of  poste- 
rior authors  from  seeking  other  paths,  and  from  proclaiming  new  prin- 
ciples. What  have  been  the  causes  of  this  scientific  revolution '?  What 
are  even  to-day  its  consequences  ?  These  are  questions  which  I  pro- 
pose to  examine  in  my  next  letter. 

■"  Hippocratic  works,  Treatise  on  Ancient  Medicine. 


THIRD   LETTER.  623 


THIRD   LETTER. 

§  I.     Causes  which  ikduced  the  Physicians  to  leave  the  Primitive  Route  of 
PuEE  Observation. 

Ai't  is  long,  life  is  short,  expei-ience  deceptive,  and  judgment  dijfficidt, 
said  Hippocrates,  when  he  was  about  to  give  to  the  public  his  Aphor- 
orisms,  that  summary  of  the  medical  science  of  his  time,  collected  by 
him  and  his  associates  in  the  temples  of  Esculapius  during  a  series  of 
centuries.  This  sentence,  which  we  must  regard  as  the  scientific  testa- 
ment of  the  greatest  physician  of  ancient  times,  contains  the  entire 
secret  of  the  intellectual  revolution  which  we  are  going  to  trace.  Phy- 
sicians abandoned  henceforth  the  path  of  pure  and  simple  observation, 
hoping  to  find  a  surer  guide  in  physio-pathological  observations,  and 
with  the  view  of  hastening  the  too  slow  progress  of  the  Healing  Art, 
of  avoiding  the  interminable  and  dangerous  gropings  of  experience,  and 
of  overcoming  the  difiiculties  of  diagnosis. 

Indeed,  the  universal  precept  of  therapeutics,  given  at  the  end  of  the 
preceding  letter  in  these  terms :  Treat  every  case  of  disease  hy  the  rem- 
edies whose  efficaciousness  in  similar  or  homogeneous  cases  has  been 
joroved  hy  experience  ;  this  precept,  I  say,  which  the  physicians  of  the 
primitive  period  had  followed  instinctively,  presupposes  the  knowledge 
of  a  treatment  for  every  morbid  species,  and  the  capacity  of  discovering 
fully  the  homogeneousness  or  similarity  of  diseases.  Now  science  is 
yet  far  distant  from  this  degree  of  perfection,  notwithstanding  the 
incontestible  progress  it  has  made  since  the  time  of  Hippocrates.  "We 
meet  in  practice,  almost  daily,  diseases  for  which  experience  has  until 
now  discovered  no  sure  remedy.  Again,  it  is  often  the  case  that  a  rem- 
edy which  formerly  was  remarkably  efiicacious  in  certain  affections, 
now  fails  in  cases  considered  as  entirely  analogous  to  them. 

In  all  these  unfortunately  too  frecjuent  circumstances,  the  above  pre- 
cept leaves  the  physician  in  embarrassment ;  it  indicates  to  him  in  no 
way  the  conduct  he  should  pursue.  The  physicians  of  the  Empirical 
school  of  Alexandria  recognized  this  void,  and  they  endeavored  to  fill  it 
by  adding  to  their  general  rule  of  therapeutics  a  corollary,  under  the 
name  of  analogism  or  epilogism.     This  corollary  was  as  follows : 


624  APPENDIX. 


EXAMPLES     OF     EMPIRICAL     ANALOGY. 

If  you  meet,  said  these  physicians,  with  a  morbid  condition  for  which 
neither  your  own  nor  others'  experience  furnishes  any  therapeutical  indi- 
cation, you  can  do  nothing  else  in  such  a  case  than  experiment.  You 
must  seek  with  what  known  affection  this  new  one  may  have  any  analogy. 
and  try  in  this  case  the  remedies  which  succeeded  in  the  former.  Thus 
the  treatment  which  has  been  employed  successfully  in  erysipelas,  might 
also  be  tried  in  certain  tetters ;  so  the  remedy  which  cured  a  rheuma- 
tism of  the  arm,  will,  in  all  probability,  cure  a  rheumatism  of  the  leg. 

They  adopted  the  same  manner  of  reasoning  when  seeking  curative 
agents  which  we  call  succedaneous  or  supplementary,  when  the  known 
means  were  not  sufficient.  Thus,  experience  having  shown  that  the  juice 
of  the  quince  was  useful  in  diarrhea,  if  they  could  not  procure  them- 
selves that  substance,  they  tried  to  replace  it  by  another  which  had  a 
sensible  analogy  to  the  first ;  for  example,  the  juice  of  the  medlar  plant, 
which  is  analogous  to  the  above  by  its  sharpness,  appeared  to  them  as 
proper  to  fullfil  the  same  indication. 

The  analogies  of  the  Empirics  were  all  founded  on  sensible  and  appa- 
rent qualities,  whether  they  applied  themselves  to  diagnosis  or  to  the 
choice  of  curative  agents.  'J'hese  analogies  appeared  too  superficial  and 
unsafe  to  the  Dogmatists.  These  preferred  seeking  more  radical  analo- 
gies, that  is  to  say,  those  founded  on  less  superficial  and  more  stable 
(qualities,  which  they  honored  with  the  names  elementary,  constitutional 
essential,  or  occult  qualities,  etc. 

EXAMPLES     OF     EMPIRICAL     EPILOCISM. 

If  a  patient  feels  in  the  hypogastric  region  intermitting  and  violent 
pains,  which  are  exasperated  in  walking  or  riding,  but  are,  on  the  con- 
trary, quieted  by  repose,  if  in  this  patient  the  emission  of  urine  is 
sometimes  suddenly  interrupted  for  a  longer  or  shorter  period,  it  may 
be  conjectured  that  the  presence  of  a  calculus  in  the  bladder  is  the 
cause  of  all  these  symptoms. 

Finally,  if  a  metal ic  sound  introduced  through  the  urethra  into  this 
membraneous  reservoir,  causes  the  hand  which  directs  it  to  feel  a  sen- 
sation of  rubbing  against  a  solid  and  ragged  body,  your  conjecture 
becomes  certainty,  for  cadaveric  researches  and  the  operation  of  lithon- 
tripsy  have  taught  us  that  a  vesicular  calculus  gives  rise,  ordinarily,  to 
such  a  concourse  of  symptoms.  Let  a  man  bitten  by  a  strange  dog, 
which  has  immediately  run  away,  present  a  few  days  afterward  symp- 
toms of  hydrophobia,  we  are  authorized  to  think  that  the  animal  was 
mad,  although  he  exhibited  no  signs  of  hydrophobia  at  the  time. 


THIRD  LETTER.  625 

Thus  we  see  by  what  use  of  reason  the  Empirics  attempt  to  go  back 
to  morbid  causes,  for  the  moment  concealed,  but  susceptible  of  falling 
under  the  senses.     They  named  them  the  occasional  or  evident  causes. 

The  Dogmatists  were  not  content  with  the  knowledge  of  this  order  of 
causes.  They  wished  to  penetrate  the  intimate  mechanism  of  the  phe- 
nomena of  nature :  they  sought  there  the  causes  called  immediate,  or 
integral,  or  essential,  etc. ;  and  they  pretended  to  establish  upon  these 
their  curative  indications. 

The  analogism  of  the  Empirics  stopped  at  those  qualities,  which  are 
regarded  as  superficial,  unimportant,  or  too  mobile ;  their  epilogism 
tended  only  to  the  discovery  of  causes  foreign  to  the  organism,  whose 
action  they  did  not  all  attempt  to  determine.  However,  these  theorists 
rejected  too  absolutely  the  lights  of  anatomy  and  physiology.  They 
did  not  comprehend  that  without  them,  diagnosis  must  fail  in  preci- 
sion, in  a  crowd  of  cases ;  that  is  to  say,  that  there  is  danger  of  consid- 
ering, as  homogeneous,  very  dissimilar  diseases,  and  as  heterogeneous 
affections,  those  which  have  the  greatest  analogies. 

The  Empirical  system,  such  as  it  has  been  transmitted  to  us  by  histo- 
rians, confines  the  human  mind  in  a  too  narrow  circle.  Xow  the  mind 
is  so  constituted,  that  it  prefers  to  go  astray  in  attempting  to  pass  the 
limits  which  have  been  imposed  to  it  by  the  Creator,  rather  than  to 
remain  thus  contracted.  In  an  epoch  when  the  jjhilosophers  pretended 
to  explain  the  enigma  of  the  universe,  or  macrocosm,  by  speculations  on 
the  atoms,  or  elements,  or  the  harmonizing  forces,  how  could  the  physio- 
logists be  prevented  from  speculating  on  the  motor  principal  of  the 
animal  economy,  on  the  elementary  humors  of  the  human  body,  on  the 
primordial  causes,  and  the  phenomena  constituting  diseases,  on  the  inti- 
mate action  of  remedies,  etc.  ? 

This  system  was  therefore  rejected  because  it  stopped  only  at  gross 
appearances,  rested  on  the  changing  ground  of  experience,  gave  no  satis- 
faction to  our  natural  desire  to  understand  causes,  and  offered  to  the 
Healing  Art  no  fixed  and  solid  basis.  Consequently,  the  primitive  way 
of  pure  observation  was  abandoned,  and  they  sought  another  route,  and 
other  principles,  which  seemed  to  guide  more  directly  to  the  final  aim  of 
medical  science,  namely :  the  preservation  of  health,  and  the  cure  of 
diseases.  They  reasoned  as  follows :  In  order  to  find  the  best  means  of 
preserving  the  health  and  life  of  the  body,  it  is  necessary  to  know  the 
parts  of  which  it  is  composed,  what  elements  constitute  it,  what  forces 
sustain  it,  and  what  laws  regulate  the  action  of  these  forces;  so,  also, 
to  be  prepared  to  cure,  certainly,  diseases,  they  must  be  known  in 
their  mode  of  formation,  their  generating  causes,  and  their  essential 


626  APPENDIX. 

phenomena.  This  was  the  unique  source,  according  to  them,  whence  could 
be  drawn  the  rational  indications  of  treatment.  Without  this  know- 
ledge, the  physician  was  likened  to  a  blind  man  armed  with  a  club,  who 
strikes  at  hazard  the  disease  or  the  patient. 

Such  is  the  argumentation,  unceasingly  presented,  under  a  thousand 
forms,  since  Hippocrates,  and  on  which  physicians  have  based  their 
ideas  for  advancing  physiology  and  pathology  to  the  first  rank  of  the 
branches  of  medical  science,  and  for  placing  therapeutics  as  secondary, 
as  being  only  a  deduction  or  corrollary  fi-om  the  preceding.  Consult  the 
most  famous  theorists  of  antiquity  and  modern  times — all,  or  nearly  all, 
reproduce  the  same  arguments  in  terms  more  or  less  explicit. 


§11.    Consequences   of  this   Scientific   Revolution. 

From  the  moment  that  it  was  admitted  as  a  principle,  that  physiology 
and  pathology  are  the  basis  of  therapeutics — that  the  treatment  of  any 
disease  whatever  ought  to  be  deduced  logically  from  the  idea  we  form  of 
its  nature,  of  its  intimate  phenomena,  and  of  its  causes — from  that 
moment,  all  the  researches  of  physicians  had  for  their  chief  end,  to 
determine  the  laws  of  life,  and  the  nature  and  mode  of  generation  of 
morbid  affections.  From  that  time,  also,  all  medication  whose  effects 
could  be  explained  according  to  the  physio-pathological  ideas  of  the  day, 
was  esteemed  rational.  All  medication,  on  the  contrary,  whose  effects 
could  not  be  in  any  way  explained  by  such  reasoning,  was  deemed  irra- 
tional or  illogical,  whatever  might  be  its  efficacy. 

In  this  order  of  ideas,  as  is  seen,  therapeutic  proof  ceased  to  be  the 
highest  criterion  of  truth  in  Medicine,  the  ultima  ratio,  that  may  be 
given  as  a  justification  in  the  choice  of  a  treatment.  Indeed,  according 
to  these  views,  in  practical  medicine,  the  physiological  explanation  of  the 
curative  action  of  medicines  becomes  the  ultima  ratio.  Such  is  the 
plan,  such  is  the  philosophy,  from  which  have  been  constructed  all  of  the 
ancient  and  modern  systems  of  Medicine,  with  the  exception  only  of 
Empiricism — Hippocratists,  Methodists,  Eclectics,  Mechanists,  Chymiater, 
Solidists,  Humoralists,  Animists,  etc.  All  these  medical  sects,  so  divided 
among  themselves,  agree  so  far  as  to  subordinate  their  curative  methods 
to  some  physio-pathological  idea  or  notion.  If  we  pass  by  the  extin- 
guished theories  before  the  end  of  the  last  century,  and  cast  a  rapid 
glance  upon  those  of  our  age,  we  will  be  easily  convinced  of  the  truth  of 
what  I  advance. 


THIRD  LETTER.  627 


ORGA  NO-DYNAMISM. 


Haller  had  published  his  great  system  of  physiology ;  his  experiments 
upon  irritability  had  filled  the  learned  world  with  admiration.  Brown, 
as  profound  a  logician  as  he  was  a  superficial  observer,  having  directed  his 
mind  upon  this  physiological  property,  believed  that  he  could  explain  by 
it,  all  the  phenomena  of  life,  and  establish  on  this  basis,  a  complete  sys- 
tem of  Medicine.  He  afiirmed  that  life  itself,  in  health  as  well  as  in 
disease,  is  an  efiect  of  stimulation,  and  of  stimulation  only  ;  that  every 
morbid  affection  consists  in  an  excess  or  a  deficiency  of  stimulus ;  that 
the  result  of  every  curative  action  reduces  itself  to  an  increase  or  dimi- 
nution of  excitement.'-' 

The  Easorians,  adopting  the  same  idea,  did  not  see  in  any  disease,  but 
an  excess  or  deficiency  of  vital  force,  a  hypersthenia  or  a  hyposthenia  ; 
and,  in  the  action  of  therapeutical  remedies,  either  an  increase  or  a  dimi- 
nution of  this  force. 

But  they  differed  from  the  Brunonians,  in  considering  excitability  as 
uniformly  diffused  in  the  animal  economy ;  whilst  the  disciples  of  Ea^'ori 
considered  it  unequally  distributed  in  the  various  tissues  and  organs. 
The  first  admitted  only  general  diseases  and  general  excitants  ;  the  latter 
recognised  special  affections,  either  in  regard  to  their  seat  or  their  nature, 
and  remedies,  whose  actions  are  manifested  by  preference,  upon  this  or 
that  organ. 

Broussais,  also,  changed  nothing  in  the  physiological  idea  of  Brown ; 
he  expressly  acknowledges  it  himself.  "  Brown,"  he  says,  "  held  as  an 
essential  principle,  that  life  is  only  supported  by  stimulants,  and  that 
to  live  is  nothing  else  than  to  be  excited.  Thus  far  this  is  true.  It  is 
very  evident  that  everything  which  sustains  life  has  no  other  percepti- 
ble effect,  to  the  sense  of  the  observer,  than  to  reanimate  the  phenomena 
to  which  we  attach  the  idea  of  life,  when  they  are  gTowing  feebler,  and 
seem  to  tend  to  their  extinction. 

"  But  to  draw  advantage  from  this  principle,  it  is  necessary  to  study 
all  the  parts  of  the  body  in  connection  with  the  external  excitants — to 
seek  in  what  manner  the  organs  excite  each  other  reciprocally — to 
study  attentively  the  effects  of  external  and  internal  excitants  in  each 
of  the  tissues  of  which  the  organs  are  composed.  Now  this  is  what 
Brown  did  not  do :  for  this  mode  of  studying  excitement  is  nothing  else 
than  the  French  doctrine,  which  bears  the  name  of  physiological  doc- 
trine, or,  if  it  is  prefered,  physiological  method."  f 

^Elements  of  Medicine  by  Brown,  chap,  m,  §  22,  23. 
f  De  Plrritation  et  de  la  Folic,  ch.  ii,  p.  47. 


628  APPENDIX. 

In  this  passage  Broussais  characterises  with  great  clearness,  the  theory 
of  Brown  and  that  of  his  own.  We  see  that  he  adopts,  without  any 
restriction,  the  physiological  principle  of  the  Scotchman  ;  but  that  he 
studies  the  effects  of  excitation,  not  in  the  economy  as  a  whole,  but  in 
each  tissue — in  each  particular  organ,  after  the  manner  of  the  Easorians. 

Perhaps  you  will  inquire  in  what  do  they  differ?  In  this  that 
the  latter  consider  the  special  action  of  most  of  external  modifying 
agents  on  every  part  of  the  organism  as  ab-irritative  or  hyposthenic — 
while  the  French  pathologist  considers  this  same  action  as  hypersthenic 
or  irritative.  Here,  then,  we  have  three  logicians,  each  possessing  extra- 
ordinary strength,  who  deduce  three  systems  from  the  same  physiolog- 
ical idea — whose  practical  conclusions  are  antagonistic  or  widely  different 
— a  curious  and  instructive  spectacle,  well  calculated  to  render  us  cir- 
cumspect in  the  application  of  physiology  to  therapeutics.  Thus  the 
French  reformer  attributed  to  his  doctrine  the  exclusive  epithet,  physi- 
ological ;  this  artifice  of  language  can  deceive  no  one.  It  is  very  evident 
that  his  doctrine  does  not  derive  more  from  physiology  than  the  two 
preceding,  nor  more  than  those  which  we  are  about  to  consider.  The 
only  difference  is  that  each  one  these  systematists  pretended  to  under- 
stand physiology  better  than  his  predecessors  and  adversaries. 


Toward  the  end  of  the  last  century  and  the  beginning  of  the  present, 
one  of  the  most  vast  and  profound  minds  which  has  honored  French 
Medicine,  Barthez,  proposed,  likewise,  to  establish  medical  practice  upon 
physiology,  in  a  work  intitled  "  Xew  Elements  of  the  Science  of  Man." 
He  declares  in  his  preface  that  such  is  his  aim  and  hope.  '•  Indepen- 
dently of  its  utility  in  metaphysics  and  morals,  the  physical  science  of 
man  presents  to  curiosity  as  great  an  attraction  as  any  other  science ; 
and  it  acquires  the  highest  degree  of  interest  when  we  see  that  it  forms 
the  foundation  of  knowledge  necessary  to  the  art  of  curing."  =■•■'  He  writes, 
in  several  other  passages,  on  the  necessary  union  which  exists  between 
physiology  and  practical  medicine,  and  he  terminates  with  indignant 
expressions  against  those  who  do  not  partake  of  his  convictions  on  this 
point. 

Barthez  admitted  in  the  human  body  three  orders  of  forces,  or  three 
dynamisms  :  First,  a  material  aggregate,  which  obeys  physico-chemical 
laws ;  second,  a  harmonizing  force,  which  he  calls  vital  principle — a 
force  which,  spread  out  in  all  parts,  and  residing  in  no  one  exclusively, 

■*New  Elements  of  the  Science  of  Man.    Paris,  1806. 


THIRD   LETTER.  629 

makes  them  sympathize  with  each  other,  coordinates  movements  to  a 
common  end — the  preservation  of  life,  and  acts  in  all  things  automatic- 
ally under  particular  laws,  without  having  conscience  either  of  its 
existence  or  its.  acts  ;  third,  and  finally,  an  immaterial  principle,  called 
soul,  endowed  with  spontaneousness  of  conscience  and  perception,  capa- 
ble of  influencing,  accidentally,  all  the  vital  functions.  The  following 
passage  may  be  cited  among  many  others,  where  this  triple  dynamism 
is  plainly  indicated. 

•'  The  order  of  the  phenomena  of  death  in  man  is  as  follows :  first,  the 
separation  of  the  soul  from  the  body ;  second,  the  extinction  of  the  forces 
of  the  vital  principle  ;  lastly,  the  chemical  dissolution  of  the  body.  =••■  '■-■ 
The  metamorphosis  of  the  terrestrial  part  of  it  is  fully  known,  but  the 
fate  of  the  vital  principle  after  death  is  a  mystery.  If  this  principle 
is  but  a  faculty  united  to  the  living  body,  it  is  certain  that  in  the  destruc- 
tion of  this  body,  it  reenters  the  system  of  forces  of  universal  nature. 
If  it  is  a  being  distinct  from  the  body  and  the  soul,  it  may  possibly 
perish  by  the  extinction  of  the  forces  of  the  body  which  it  animates, 
or  it  may  pass  into  other  human  bodies  and  vivify  them  by  a  kind 
of  metempsychosis."  " 

Barthez  doubted  the  independent  existence  of  the  vital  principle,  dis- 
tinct from  that  of  the  body  and  the  soul,  or  whether  it  be  but  a  modality 
of  organized  matter,  a  faculty  endowed  with  motor  forces,  which  are 
the  necessary  consequences  of  the  material  combination  of  which  each 
animal  body  is  formed. 

M.  Lordat,  the  inheritor  and  perpetuator  of  this  doctrine,  does  not 
hesitate  to  raise  this  doubt.  He  afilrms  that  the  mysterious  principle 
which  gives  impulse  to  the  animal  economy  enjoys  an  independent  exist- 
ence, separated  from  that  of  the  body  and  the  soul.  He  consecrates  to 
the  demonstration  of  this  opinion  an  entire  book,  under  the  title  of 
Insenescence  Du  Sens  Litinie. 

I  must  confess,  that  the  school  of  Montpellicr  appears  to  me  to  be  in 
possession  of  a  physiological  truth  of  high  importance,  which  it  is  right 
not  to  abandon.  Its  doctrine  on  the  vital  principle  or  the  harmonizing 
force  of  organized  bodies,  is  very  justly  named  Hippocratic.  It  is 
indeed  stated  in  several  of  the  writings  attributed  to  the  physician  of 
Cos,  who  gives  to  the  harmonizing  force  of  the  living  organism  divers 
names.  He  calls  this  force,  according  to  the  aspect  under  which  he 
regards  it,  either  motor  euopfxov,  or  nature  (^'O^c;;,  etc.  We  read,  among 
other  things  in  the  Treatise  on  Aliment :  '•  Nature  is  equal  to  and 
sufficient  for  all  things.    *  =  ■=    There  is  in  the  interior  an  unknown 


'  Ibidem.    Last  chap.,  cccxvi  and  cccxvit,  book  II. 


630  APPENDIX. 

agent  who  works  for  the  whole  and  for  the  parts;  sometimes  for  certain 
ones  and  not  for  others.  =•'  Nature  is  one  in  all,  but  infinitely 

varied.    •'     "  There  is  but  one  end ;  there  is  but  one  effort.     The 

entire  body  participates  in  it ;  it  is  a  universal  sympathy."  '^"- 

This  opinion,  derived  from  the  philosophy  of  Pythagoras,  renewed  by 
Leibnitz,  has  been  adopted  by  a  large  number  of  naturalists  and  physi- 
cians of  all  countries  and  all  times.  It  appears  to  be  generally  followed 
in  Germany.  M.  Miiller,  Professor  in  the  University  of  Berlin,  after 
having  discussed  it  with  great  depth  and  impartiality,  concludes  by 
inclining  to  it.  f  But  we  do  not  intend  to  examine  here  how  far  such  a 
doctrine  is  founded  in  physiology.  We  have  to  occupy  ourselves  only 
in  regard  to  its  consequences  upon  practical  medicine. 

Now,  from  the  moment  that  we  recognize  in  human  nature  a  triple 
dynamism,  to-wit :  an  aggregate  material,  a  vital  harmonizing  force, 
and  an  immaterial  essence  whose  determinations  react  sometimes  on  the 
living  organism,  we  must  admit  that  each  one  of  these  dynamisms 
reveals  itself  to  the  eyes  of  the  observer  by  special  functions  which  may 
be  injured  either  separately  or  simultaneously.  Thence  result  three 
general  classes  of  diseases.  The  first  class  comprises  the  physico-chem- 
ical alterations  of  the  solids  and  fluids ;  the  second,  the  lesions  of  the 
vital  force  or  properties ;  the  third,  the  affections  of  the  soul.  Such 
is,  indeed,  the  nosological  classification  indicated  by  M.  Barthez.  \  I 
do  not  intend  to  consider  here  the  grave  objections  which  might  be 
raised  against  this  classification  of  diseases.  I  pass  immediately  to 
the  practical  consequences  which  result  from  it,  according  to  its  author, 
who  expresses  himself  in  the  following  language:  "  My  new  doctrine  on 
the  faculties  and  functions  of  the  vital  principle  being  rigorously 
deduced  from  facts,  and  independent  of  all  the  systems  of  the  differ- 
ent sects  in  the  Science  of  Man,  does  not  exclude  any  of  the  views 
which  are  essential  to  recognize,  to  perfect  and  to  multiply  all  the  meth- 
ods, natural,  analytical  and  empirical,  which  the  art  of  curing  may 
embrace  in  the  treatment  of  the  divers  kinds  of  disease." 

But  let  us  now  permit  M.  Lordat  to  explain  to  us  what  are  the  thera- 
peutic methods  to  which  he  makes  allusion  :  "  The  Natural  methods  are 
those  whose  object  is  to  favor,  to  accelerate  or  to  regulate  the  course 
of  diseases  which  tend  to  a  happy  solution.  *  =■■'  =•■•=  The  Analytic 
methods  are  those  in  which,  after  having  decomposed  a  disease  into  its 
essential  affections  which  produced  it.  or  into  the  more  simple  diseases 

"  Works  of  Hippocrates.    Treatise  on  Aliments,  §§  3  and  4. 

f  Manual  of  Physiology. 

X  New  Elements  of  the  Science  of  Man.    Preliminary  Discourse. 


THIRD   LETTER.  631 

■which  complicate  it,  we  then  attack  directly  these  elements  of  disease,  by 
means  proportioned  to  their  relations  of  force  and  of  influence.  '■•'  *  ^■■* 
The  Empirical  methods  are  those  whose  efficacy  have  been  established  by 
experience,  but  whose  immediate  and  primitive  efi"ects  have  no  connec- 
tion with  the  cure  of  the  disease,  intelligible  to  our  minds."  " 

This  classification  of  therai)eutical  methods  is  very  important,  and 
merits  a  profound  discussion,  upon  which  I  shall  not  again  enter  here,  as 
I  have  treated  it  fully  already  in  the  Article  on  Animism  and  Vitalism. 
I  will  add  to  what  I  have  said  there,  but  a  simple  reflection :  How  is  it 
that  Barthez,  who  pretends  to  found  therapeutics  on  physiology,  did  not 
see  that  there  does  not  exist  any  rational  connection,  any  coiTclation 
which  the  human  mind  may  appreciate,  between  his  triple  dynamism  or 
his  physiological  ternary,  and  the  three  modes  or  general  plans  of  curing 
above  given  ?  However,  far  from  blaming  him  for  having  tried  to  ren- 
der practical  medicine  independent  of  all  systems  of  physiology  and 
pathology,  I  praise  him,  on  the  contrary,  highly  for  it.  What  I  blame 
him  for  is,  not  to  have  been  able  not  to  render  it  independent  of  his  own 
system,  as  well  as  those  of  others.  He  could  then  have  established 
a  true  and  lasting  doctrine  of  therapeutics,  instead  of  which  he  has 
only  shed  a  ray  of  light  on  this  important  and  difficult  branch  of  medi- 
cal science.  Nevertheless,  this  ray  of  light  is  a  service  rendered  to  pos- 
terity, which  has  accepted  it,  and  by  freeing  it  from  the  shadows  and 
errors  with  which  it  is  still  enveloped,  will  cause  it  to  shed  forth  a  clear 
and  vivifying  light. 

HOMEOPATHY. 

No  one  has  raised  himself  with  more  force  and  perseverance  against 
all  physiological  and  pathological  systems  than  the  author  of  the  home- 
opathic doctrine.  He  wars  against  them  from  the  beginning,  in  all  his 
writings,  but  particularly  in  a  pamphlet  entitled,  "  Value  of  Medical 
Si/stems  ;"  and  in  the  paragraph  of  his  Materia  Medica,  entitled,  A 
Souvenir,  he  declares  emphatically  that  Medicine  is  and  only  can  be 
but  an  empirical  science,  the  same  as  physics  and  chemistry. f  He 
charges  the  pathologist,  sometimes  with  creating  imaginary  morbid 
entities,  purely  nominal,  by  means  of  symptoms  grouped  arbitrarily,  and 
sometimes  with  seeking  the  cause  of  the  ills  which  afflict  man  in  the 

"^  Explanation  of  the  doctrine  of  Barthez,  by  M.  Lordat. 

f  True,  Medicine  is,  from  its  nature,  simply  an  empirical  science,  and  can  only 
be  based  upon  pure  facts  and  sensible  phenomena  belonging  to  its  sphere.  ^'  "' 
In  the  purely  empirical  sciences,  as  Physics,  Chemistry,  and  Medicine,  the  purely 
speculative  mind  must  not  be  allowed  any  decisive  influence. —  Organoji,thc  Art 
of  Curing. 


632  APPENDIX. 

depths  of  physiological  abstractions,  such  as  the  diverse  degrees  of 
lesions  which  sensibility,  irritability,  and  nutrition  may  undergo.  He 
attacks  them  with  the  weapons  of  reason  and  ridicule.  He  adjures  them, 
in  the  name  of  conscience  and  religion,  to  renounce  such  errors. 

Who  would  not  expect,  after  so  many  declamations,  that  the  founder  of 
Homeopathy,  the  inventor  of  infinitesimal  doses,  would  abstain  entirely 
from  all  physiological  explanation  ?  that  he  would  invoke  in  favor  of 
his  doctrine  experience  only,  pure  experience,  as  he  incessantly  repeats  ? 
Well,  undeceive  yourself.  The  whole  explanation  of  his  system  is,  from 
beginning  to  end,  but  a  physio-pathological  theory,  a  long  dissertation 
on  the  essence  of  disease,  and  the  intimate  action  of  medicines.  He 
says,  for  example,  that  diseases  are  but  the  immaterial  alterations  of  an 
imp>alpahle  vital  principle  ;  hence  he  concludes  that  we  must  attack  them 
by  forces  of  the  same  kind,  that  is  to  sa}",  by  spiritual  virtues  of 
medicines." 

He  asserts,  for  example,  that  two  affections  alike  in  their  symptoms, 
but  different  in  their  essence,  destroy  each  other  when  they  meet  in  the 
same  organism ;  he  proves  this,  not  by  observation,  but  by  the  most 
subtile  argument,  and  one  of  the  most  arbitrary  hypotheses,  f  I  will 
not  dwell  longer  on  this  doctrine,  which  I  propose  to  submit  hereafter 
to  a  special  examination.  It  is  sufficient  for  the  moment  to  have  dem- 
onstrated by  striking  proofs  that  Samuel  Hahnemann,  after  having  stu- 
pidly reprimanded  the  theorists  who  pretend  to  base  therapeutics  on 
considerations  drawn  from  physiology  and  pathology,  falls  himself  into 
the  same  fault  with  which  he  reproaches  others.  Besides,  a  much  more 
eminent  physiologist,  Bichat,  has  committed  quite  the  same  inadver- 
tence. After  having  charged  the  influence  of  the  physio-pathological 
theories  as  being  the  cause  of  the  instability  of  the  denominations  of 
the  Materia  Medica,  and  of  the  vagueness  and  incoherence  of  therapeu- 
tics, he  throws  us  back  into  the  same  path,  by  affirming  that  the  action 
of  curative  agents  reduces  itself  to  restoring  the  vital  forces  to  their 
natural  type,  from  which  they  were  diverted  by  disease.; 

ECLECTICISM. 

I  have  but  two  words  to  say  here  upon  this  doctrine,  of  which  I  shall 
speak  elsewhere  at  more  length.  I  wish  to  observe  only,  that  it  aspires, 
like  the  preceding,  to  establish  its  curative  indications  on  physio-patho- 
logical views  and  facts.  The  eclectic  does  not  accept  entirely  any  one 
of   the  physio-pathological  interpretations  proclaimed  by  the  diverse 

"  Organon,  sec.  53,  etc.  f  Ibidem,  §  40. 

X  General  Anatomy — General  Considerations,  §  u. 


THIRD   LETTER.  633 

systems,  but  neither  does  he  deny  any  one  in  an  absolute  manner.  He 
pretends  to  draw  from  each  one  of  them  what  is  suitable  to  him,  with- 
out subjecting  himself  to  any  fixed  rule,  and  puts  experience  and  rea- 
son in  the  scale  in  order  to  decide  on  each  particular  case. 

But  within  what  limits  does  he  interrogate  these  two  faculties,  or 
these  two  modes  of  act|uisition  ?  This  is  what  the  Eclectic  never  tells 
us ;  thus  he  gives  us  no  assurance  that  we  shall  not  make  choice  of 
error  rather  than  truth,  of  deceptive  fiction  rather  than  reality. 

Medical  Eclecticism  escapes  all  general  description  by  the  absence  of 
a  common  formula  and  a  fixed  symbol.  The  eclectics  have  among  them- 
selves very  often  nothing  else  in  common  but  their  names,  and  a  decided 
aversion  for  the  discussion  of  principles.  But  it  is  true,  that  far  from 
denying  the  physio-pathological  theories,  they  seek  them,  and  endeavor 
to  deduce  therefrom  their  methods  of  treatment. 


III.     CONCLUSION. 

We  have  seen  that  at  an  undetermined  epoch  in  the  history  of  Medi- 
cine a  capital  revolution  took  place  in  this  science ;  that  the  method  of 
pure  observation  had  been  abandoned,  to  follow  another  route,  in  appear- 
ance shorter,  surer,  and  more  rational ;  thinking  that  the  study  of  the 
elements  of  the  body  and  their  properties,  of  the  laws  which  govern  the 
functions  of  the  animal  economy,  and  of  the  causes  and  production  of 
diseases,  would  establish  the  Art  of  Curing  upon  a  firmer  basis  than 
crude  results  of  experience.  Henceforth,  there  was  established  among 
physicians  a  general  opinion,  which  considered  therapeutics  as  a  deduc- 
tion, a  corollary  form  the  laws  of  physiology  and  pathology. 

A  single  sect  in  antiquity  resisted  this  idea,  and  tried  to  trace  another 
plan  of  studies,  and  other  rules  of  practice ;  but  it  perished  after  a 
short  popularity ;  its  name  and  its  memory  were  for  a  long  time  held 
in  dishonor  by  medical  posterity.  However,  since  the  revival  of  letters 
in  Europe,  more  than  one  philosopher,  more  than  one  physician  of  high 
reputation,  has  dared  to  judge  this  doctrine  less  severely. 

The  testimonials  in  favor  of  rational  Empiricism  are  not  wanting 
among  the  writings  of  the  two  last  centuries,  and  these  evidences  become 
more  and  more  numerous  and  imposing  as  we  approach  the  present  epoch. 
In  our  day  a  multitude  of  authors  are  animated  with  the  spirit  of  Em- 
piricism, and  proclaim  its  maxims  without  rallying  openly  under  its 
flag.  Those  who  oppose  it  most  warmly  in  their  books,  in  theory,  do  not 
hesitate  to  take  it  for  a  guide  in  their  practice  at  the  bed  side.  There 
exists  even  in  Paris  an  entire  class  of  Physicians,  united  under  the 
name  of  the  "  Society  of  Medical  Observation,"  which  has  emitted 
40 


634  APPENDIX. 

principles  and  metliod,  evidently  empirical,  whose  doctrine,  though  still  in 
the  embryonic  state,  includes  in  France,  as  well  as  in  foreign  countries, 
numerous  adherents.' ■  Upon  the  whole,  there  prevail  at  this  time  in 
Medicine,  three  opinions,  three  general  methods.  One  pretends  to 
deduce  all  therapeutical  indications  from  the  laws  of  physiology  and 
pathology.  We  will  designate  it  by  the  term  physio-pathologism.  The 
other  affirms  that  no  mode  of  treatment  can  be  derived  from  physio- 
pathological  notions  in  a  direct  and  immediate  manner,  and  draws  all  of 
its  practical  rules  from  the  pure  results  of  experience  ;  this  is  the  old 
Empiricism,  which  we  name  rational  Empiricism,  or  Empiri-methodism. 

The  third,  which  derives  its  curative  indications,  sometimes  from 
physio-pathological  ideas,  and  sometimes  from  crude  facts  of  experience 
is  medical  Eclecticism. 

These  three  opinions,  these  three  methods,  are  contradictory,  as  it  is 
easy  to  see ;  one  of  them  being  true,  the  other  two  must  necessarily  be 
false.  It  is  then  of  the  greatest  importance  to  make  correct  choice,  for 
on  this  choice  depends  all  the  future  of  medical  practice.  To  remain  in 
doubt  is  impossible,  at  least  in  practice  ;  to  decide  by  chance  in  a  matter 
which  interests  to  such  a  degree  the  health  and  life  of  mankind,  would 
be  the  act  neither  of  a  philosopher,  nor  of  an  honest  man.  We  proceed, 
consequently  to  treat,  with  all  the  development  which  it  merits,  in  our 
next  chapter,  the  following  capital  question :  Can  pathological  physi- 
ology, in  whole  or  in  part,  he  the  direct  and  immediate  foundation  of 
therapeutics. 

■'-  See  first  Memoir  of  Medical  Society  of  Observation,  1837. 


FOURTH  LETTER.  63-' 


FOURT.H    LETTER. 


CAN'  PATHOLOGICAL  PIIi'SIOLOGr  BE,   IX  WHOLE  OR    IX   PART,  THE    DIRECT  AND 
IMMEDIATE  FOUNDATION  OP  THERAPEUTICS. 


§  I.     Presext  state  of  Science  relative  to  this  Question. 

I  said,  in  terminating  my  preceding  Letter,  that  three  contradictorj 
opinions  are  exhibited  on  the  suhject  of  the  above  announced  question-. 
The  one  which  has  for  supporters  the  most  famous  modern  systematists, 
such  as  Stahl,  Barthez,  Brown,  Razori,  Bichat,  Broussais,  and  other  nu- 
merous votaries,  affirms  that  there  is  no  rational  therapeutics  except 
what  is  derived  from  the  exact  knowledge  of  the  disease,  and  the  mode 
of  action  of  curative  agents.  All  those  illustrious  theorists  whose  doc- 
trines have  divided  the  medical  world,  suppose  that  pathological  physi- 
ology is  the  only  rational  and  necessary  basis  of  practical  medicine: 
All  pretend  to  derive  from  this  unique  source  their  methods  of  treat- 
ment, and  the  explanation  of  the  effects  which  they  obtain.  I  call  them 
pure  physio-pathologists. 

The  second  opinion  is  that  of  the  less  exclusive  Vitalists,  and  of  less 
pure  Organics,  of  all  those,  in  one  word,  who  under  divers  names,  prac- 
tice more  or  less  openly  Eclecticism.  These  physicians  agree  with  the  pro- 
ceding,  that  the  knowledge  of  the  intimate  nature  of  maladies  and  the 
mode  of  action  of  remedies  constitute,  in  fact,  the  best  foundation  of 
therapeutics.  But  they  add,  that  in  default  of  this  knowledge,  which 
too  often  is  wanting,  the  crude  observation  of  the  effects  of  agents,  or 
Empiricism,  may  serve  us  as  a  guide,  and  furnish  us,  in  certain  diseases, 
surer  and  more  efficacious  means  of  cure  than  those  which  are  indicated 
by  rational  Medicine.  They  regard  the  physiological  explanation  of  the 
action  of  remedies  the  last  improvement  of  the  Art,  the  final  aim  of  the 
science,  but  they  think  we  are  still  very  far  removed  from  this  degree  of 
perfection,  in  many  cases. ^ 

''  See,  among  others : 

Andral — CUnique  Medlcale,  second  edition,  preface,  page  6;     Course  de  Pathol- 
;jie  Interne,  preliminary  considerations. 


636  APPENDIX. 

Thirdly,  and  finalty,  there  are  some  authors  who  maintain  that  rude 
experience,  or  pure  observation  of  the  sensible  eiFects  of  remedies,  is  the 
fundamental  base  of  therapeutics.  These  deny,  positively,  that  the 
lights  of  physiology  and  pathology  can  ever  become  the  immediate  source 
of  curative  indications,  or  furnish  a  rational  explanation  of  therapeutical 
effects.  I  have  called  this  sect  of  physicians  by  the  name  of  rational 
Empirics  or  Empiri-methodists.* 

A  general  remark,  to  be  made  on  all  the  modern  writers  of  Medicine, 
to  whatever  category  they  belong,  is,  that  they  do  not  hesitate  to  resolve, 
or  rather  to  settle,  the  great  question  which  is  the  subject  of  this 
letter,  but  they  do  not  bring  forward  any  proof  of  the  solution  which 
they  give  of  it.  Each  one  of  them  seems  to  imagine  that  the  opinion 
which  he  professes  in  this  regard  is  so  clear  and  evident  that  it  is  suf- 
ficient simply  to  announce  it ;  they  dispense,  in  this  belief,  with  all 
efforts  at  seeking  its  demonstration. 

However,  they  should  all  consider  that  this  evidence  is  not  of  such  a 
nature  as  to  convince  all  minds,  since  there  is  found  among  their  cotem- 
porarics,  a  considerable  number  of  distinguished  savans  and  respectable 
practitioners,  who  profess  entirely  different  and  even  contrary  principles. 
This  consideration  ought,  it  seems  to  me,  to  shake  the  faith  of  each 
of  these  sections  in  their  respective  doctrine,  and  cause  them  to  follow 
us  in  the  examination  of  the  fundamental  problem  above  stated. 

Bouillaud — Nosographie  Medceale. 

Forget,  Professor  at  Strasburg — Feuilleton  de  1' Union  Medecale.    1849. 

Frank  (Jos.) — Innere  Pathologie. 

Gendrin — Traite'  Philosophique  de  Mede'cine  Pratique.  This  author  combats 
Eclecticism,  nevertheless,  he  must  be  ranked  among  the  eclectics. 

Guein — ■Memoir  sur  Eclecticism  in  Mede'cine.     1831. 

Piorry — Traite  Pathologie  latrique  ou  Medicale. 

Requin — Elemens  de  Pathologie  Medicale. 

Reveille — Parise.    Etudes  dc  PHomme,  dans  I'Elat  de  Sante  et  de  Maladie. 

Trousseau  et  Pidoux — Traite  de  Therapeutique  et  Matiere  Medicale. 

"  We  cite  some  authors  who  have  professed,  more  or  less,  this  doctrine  : 

Berard  (F.) — Doctrine  Medicale,  de  I'Ecole  de  Montpellier  ;  pages  198  to  201, 
and  423  to  459. 

Becquerel — De  I'Empiricism  en  Medicine.  Thesis  for  the  concour  of  agrege'. 
Paris,  1844. 

Gibert — Fragments  Therapeutique  et  de  Medecine  Pratique  ;  1846. 

Laennec — Traite  de  I'Auscultation  Mediate,  second  edition  ;  preface,  pages  2") 
to  31. 

Louis — Memoires  de  la  societie  Medicale  d'Observation,  vol.  I.  p.  42. 

Valleix — Guide  du  Medicin  Praticien.     We  ought  to  range  in  the  same  line : 

Chomel — Pathologie  Generale. 

■Grisolle — Traite  Elementaire  et  Pratique  de  Pathologie  Interne. 


FOURTH  LETTER.  637 


§  n.  Philosophical  Axioms  Aiding  tue  Solution'  of  this  Problem. 

I.  Sensible  objects  being  known  to  us  only  by  the  impressions  they 
make  upon  our  senses,  the  mind  does  not  perceive  anything  in  these 
objects  beyond  the  sensations  which  they  excite  in  us. 

II.  Xo  corporeal  operation,  nor  any  action  of  the  soul  on  its  proper 
faculties  or  on  its  ideas,  can  make  us  conceive  the  acting  force  of  the 
causes,  or  the  necessary  connection  they  have  with  their  effects. 

COROLLARY. 

In  the  succession  of  natural  phenomena,  there  is  nothing  which  pre- 
sents the  idea  of  causality,  or  the  necessary  connection  of  cause  and  effect. 
But,  when  a  succession  of  phenomena  is  constant,  the  human  mind, 
which  observes  it  assiduously,  and  which  often  may  foresee  it,  is  forced  to 
believe  that  these  phenomena  succeed  each  other  because  they  are  linked 
together.  A  ball,  for  example,  thrown  on  a  horizontal  plane,  strikes 
another  ball  which  was  in  a  state  of  repose  ;  this  latter  moves  immedi- 
ately in  its  turn.  The  impulse  of  the  first  will  be  regarded  as  the  cause 
of  the  movement  of  the  second ;  however,  the  mind  does  not  perceive 
any  necessary  connection  between  these  two  phenomena,  but  their  con- 
stant succession,  which  is  manifested  each  time  that  we  seek  the  proof. 
forces  us  to  believe  that  these  phenomena  follow  because  they  are  con- 
nected.     This  is  an  empirical  truth  and  certainty. 

The  two  axioms  above,  and  the  corollary  which  follows  them, 
ought  to  be  regarded  as  incontestible  principles,  since  they  conform 
to  the  doctrine  of  all  the  modern  philosophic  schools  on  this  mat- 
ter. We  can  easily  find  its  substance  in  the  writings  of  Bacon, 
Locke,  Hume,  and  Condillac,  for  the  sensitist  or  empirical  school ;" 
in  those  of  Thomas  Pieid  and  his  disciples,  for  the  Scotch  school, 
called  school  of  common  sense  ;f  in  these  of  Kant,  for  the  spirit- 
ualist or  rationalist  school  ;|  finally,  in  those  of  M.  Cousin  and  his 
numerous  followers,  for  the  eclectic  school.  §  To  these  authorities 
we  must  add  that  of  Barthez,  whose  doctrine,  though  now  half  a 
century  old,  still  prevails  in  spirit  in  the  University  of  JNIontpellier ;,! 
and  that  of  M.  Buchez  also  has  put  forth  very  recently,  on  medical 

*  Bacon  de  Verulam. — Organum  Novum,  Liber  I,  chap.  1.  Locke,  Philos 
Essay  on  the  Human  Understanding,  lib.  IV,  ch.  iii,  §  16  ami  26.  Condillac, 
Essai  sur  I'Origine  des  Connaissances  Humaines. 

t  Inquiries  on  the  Human  Understanding. —  Th.  Reid. 

-[•  Critik  der  Reinen  Vernunft. 

§Cours  de  I'Histoire  de  la  Philosophie  Modern. —  Cousin. 

II  See  different  passages  of  Nouveaux  Elemeus  de  la  Science  de  I'Homme. 


638  APPENDIX. 

and  historical  studies,  some  new  and  profound  views.  According  to 
him,  the  aim  of  science  is  to  foresee,  and  there  exist  two  degrees  of 
foresight :  the  first  consists  in  the  knowledge  of  the  order  of  succession 
of  phenomena ;  the  second,  in  the  knowledge  of  the  law  of  generation 
(if  these  phenomena.  Two  conditions  are  indispensahle,  in  order  that 
we  may  arrive  at  the  knowledge  of  the  order  of  succession  of  phenom- 
na  :  First,  that  the  phenomena  of  the  same  order  and  same  nature  fol- 
loio  each  other  always,  according  to  a  constant  unknown  hut  invariable 
laiv ;  second,  that  the  entire  succession  of  these  phenomena  has  been 
observed  once  at  least  in  its  ivhole  extent.  This  being  stated,  our  philoso- 
pher examines  the  degree  of  foresight  which  each  branch  of  the  human 
encyclopedia  appears  to  have  attained,  and  he  uses  the  following  lan- 
guage on  the  subject  of  physiology:  "In  the  sciences  of  organized 
bodies,  scientific  foresight  is  reduced  every  where  to  the  knowledge,  yet 
incomplete,  of  the  order  of  succession  of  phenomena.  This  is  espe- 
cially so  in  Medicine,  for  whether  you  study  the  development  of  a  path- 
ological modification,  or  observe  the  order  in  which  the  phenomena 
succeed  each  other,  to  constitute  a  morbid  affection,  or  whether,  finally, 
you  analyze  the  successive  effects  engendered  by  the  introduction  into 
the  animal  economy  of  a  therapeutical  agent,  your  only  aim  is  always 
to  find  out  the  order  in  which  the  phenomena  of  a  determined  nature 
succeed  each  other,  so  that  in  similar  successions  you  may  subsequently 
encounter,  you  may  be  able  to  foresee  what  is  to  follow  by  means  of  what 
has  already  taken  place.  Scientific  foresight  will  always  stop  there, 
until  the  general  formula  of  the  organized  bodies  shall  have  been 
found."- 

In  presence  of  such  a  mass  of  eminent  testimonials,  scepticism 
becomes,  impossible.  A  doctrine  which  has  obtained  the  assent  of  so 
many  philosophers  in  other  respects  so  divided,  could  not  lead  us  into 
error.  We  may  well  therefore  rely  with  confidence  upon  it,  in  order  to 
resolve  the  important  and  difficult  problem  announced  at  the  head  of 
this  letter. 


III.  REPLY  TO  THIS  QUESTION  :  CAN  PATHOLOGICAL  PHYSIOLOGY  BE,  IN  TOTAL- 
ITY OR  IN  PART,  THE  DIRECT  AND  IMMEDIATE  FOUNDATION  OF  THERA- 
PEUTICS? 

It  is  easy  to  see  that  this  question  amounts  to  the  following:  Know- 
ing the  series  of  phenomena  which  constitute  a  morbid  affection,  can  we 

*■■'  Introduction  a  FEtude  des  Sciences  Medicales,  premier  lecon. 


FOURTH  LETTER.  639 

deduce  from  it,  a  priori,  the  knowledge  of  the  successive  effects  which 
will  result  from  the  intervention  of  a  new  force  (a  therapeutic  agent) 
in  the  midst  of  these  phenomena?  Our  reply  to  the  question  thu?f 
stated  is  not  doubtful,  if  we  remember  our  philosophic  axioms  and  the 
commentary  of  M.  Buchez.  No,  we  say,  no,  it  is  not  possible  that  the 
knowledge  of  a  succession  of  morbid  phenomena  can  enable  us  to  fore- 
see the  changes  which  a  curative  agent  will  introduce  into  such  suc- 
cession, before  these  changes  may  have  been  observed  at  least  once. 

The  lights  of  pathological  physiology,  to  whatever  degree  they  may 
have  attained,  can  never  give  us  the  foresight  of  the  effect  a  therapeu- 
tic agent  must  produce  in  the  animal  economy,  before  these  effects  have 
been  directly  observed.  From  which  it  follows  that  the  indications 
which  flow  from  physio-pathological  knowledge  on  the  opportunity  of  a 
treatment,  are  reduced  to  simple  conjectures,  before  that  treatment  has 
been  tried  once  at  least.  It  is  not  until  after  a  first  trial  that  the 
veritable  foresight,  or  in  other  words,  science  begins.  Thus  the  physio- 
pathology  can  not  he  in  any  case  the  direct  arid  immediate  foundation  of 
therapeutics. 

There  are  some  examples  which  will  prove  and  confirm  the  truth  of 
this  answer  to  the  minds  of  those  persons  who  do  not  distrust  absolute 
and  abstract  principles,  in  consequence  of  the  abuse  which  has  been 
made  of  these  principles.  But  in  order  not  to  leave  in  their  minds  any 
cloud,  or  any  motive  to  doubt,  I  will  take  these  examples  from  the  very 
authors  who  are  of  a  contrary  opinion  to  the  one  I  have  emitted.  I  shall 
liave  on  this  point  but  the  embarrassment  of  a  choice,  for  it  is  now  the 
custom  among  our  writers  in  Medicine  to  establish  the  curative  indica- 
tions on  physio-pathological  facts,  rather  than  upon  the  crude  observa- 
tion of  the  sensible  effects  of  medicines. 

Eead  most  of  the  treatises  on  Medicine  which  have  been  published  in 
the  last  half  century,  and  you  will  find  but  few  in  which  we  can  not 
distinguish  two  kinds  of  therapeutics. 

One  they  call  rational,  founded  on  the  physio-pathological  ideas  of 
the  day  ;  the  other  they  name  empirical,  or  irrational,  founded  on  the 
common  observation  of  the  effects  of  remedies.  The  writers  who  estab- 
lish such  a  distinction,  announce  thereby  that  the  choice  of  a  remedy  is 
in  their  eyes  not  sufficiently  justified  by  the  experimental  notion  of  its 
efficacy ;  and  a  treatment  merits  the  title  of  rational  only  in  propor- 
tion as  it  can  be  shown  in  virtue  of  what  physiological  modification  it 
effects  a  cure.  In  a  word,  it  is  the  knowledge  of  the  intimates  modifi- 
cation produced  by  the  curative  agents  which  constitutes,  according  to 
these  authors,  the  rationality  of  therapeutics,  the  supreme  perfection  of 
the  Art. 


640  APPENDIX. 

One  of  our  cotemporaries,  whose  opinions  are  distinguished  by  clear- 
ness and  exactness,  expresses  himself  in  the  following  language  on  this 
subject:  '' Medtcme  is  rational  vrhenever  it  bases  the  employment  of 
any  remedies  on  the  consideration  of  their  physiological  eiFects.  The 
indications  of  these  remedies  are  found  by  a  process  of  reasoning  in  which 
the  physiological  effects  are  the  principles,  and  the  therapeutic  effects 
the  conclusion.  There  is  a  logical  connection  between  the  latter  and 
the  former." 

"  Second.  Medicine  is  empirical,  not  in  the  bad  sense  of  the  word, 
but  in  all  the  dignity  of  its  etymological  sense,  whenever  the  remedies 
it  prescribes  have  for  reason,  not  a  physiological  deduction  or  induction, 
but  clinical  experience  only.  Without  doubt,  physicians  may  seek, 
when  the  utility  of  an  empirical  remedy  is  well  observed,  to  explain  it 
by  physiological  theories  more  or  less  plausible,  as  on  the  other  hand 
they  seek  to  demonstrate  by  the  evidence  of  experience  the  value  of 
rational  remedies  ;  for  reasoning  and  experience  ought  naturally  to  tend 
to  unite  themselves  in  the  precepts  of  the  Art.  But,  in  a  last  analysis 
the  distinction  of  therapeutical  remedies  into  rational  and  empirical  is 
always  fundamentally  true. 

"  But  how  will  the  practitioner  reply,  for  example,  when  he  is  asked, 
on  the  one  hand,  why  he  purges  a  man  who  is  constipated,  and  on  the 
the  other  hand,  why  he  purges  a  man  attacked  with  lead  colic  ?  To 
the  first  question  he  will  reply,  rationally,  I  purge  to  evacuate  the 
fecal  matter.  To  the  second  question  he  will  reply,  empirically,  I 
purge  because  purgation  cures  lead  colic." 

Such  is  the  argument  which  I  extract  literally  from  a  treatise  on 
Medicine  which  is  now  being  published.-' 

For  myself,  the  more  I  examine  and  compare  the  two  answers  quoted 
in  the  last  passage,  the  more  I  find  them  identical,  that  is  to  say. 
equally  rational  and  equally  empirical.  Indeed,  when  a  person  answers, 
I  purge  in  order  to  evacuate  fecal  matter,  is  it  not  equivalent  to  say- 
ing, I  administer  such  a  remedy  because  experience  has  taught  me  that 
it  relieves  constipation?  And  again,  when  one  answers:  I  purge  to 
cure  lead  colic,  does  he  not  say  as  much  as,  I  administer  such  a  remedy 
because  experience  has  taught  me  that  it  cures  lead  colic  ? 

In  the  first  case,  as  in  the  second,  you  have  nothing  else  but  an 
experimental  notion  of  the  therapeutical  effect.  How  do  you  know,  for 
example,  that  the  powder  of  jalap  will  provoke  the  evacuation  of  fecal 
matter  ?     By  clinical  observation.     How  do  you  know  that  the  same 

*^  Elemens  de  Pathologie  Medicale ;  par  M.  Requin,  1. 1,  p.  250,  121. 


FOURTH  LETTER.  641 

substance  will  quiet  lead  colic?  Equally  by  clinical  observation. 
Why  then  do  you  call  the  knowledge  of  the  first  eflPect  rational,  and 
that  of  the  second  empiricaU  To  this  you  cannot  answer  by  subtilties 
and  the  quibbles  of  the  sophist ;  or  rather,  your  enlightened  reason, 
directed  by  the  philosophic  axioms  above  given,  will  force  you  to  agree 
that  you  have  established  an  erroneous  distinction  between  facts  of  the 
same  order. 

Let  us  see  other  examples  of  pretended  rational  Medicine.  Perhaps 
they  will  sustain  an  examination  better  than  the  preceding:  "  In  clini- 
cal surgery,"  says  the  honorable  M.  Bouillaud,  "  cases  are  not  rare  where 
rational  therapeutics  is  employed.  Indeed,  to  reduce  a  luxated  bone  by 
bringing  into  play  muscular  action  in  an  inverse  direction  to  that 
which  produced  it ;  to  extract,  either  by  a  bloody  operation  or  by  lith- 
otrity,  a  stone  from  the  bladder ;  to  dilate  strictured  canals  or  to  make 
a  substitute  for  them  by  artificial  means ;  to  ligate  a  wounded  artery, 
etc.  etc.,  these  are  purely  rational  therapeutical  proceedings."" 

In  order  to  judge  in  what  respect  the  last  examples  which  we  have 
cited  merit  the  title  of  rational,  I  beg  the  reader  to  remember  the  corol- 
lary of  our  philosophical  axioms.  It  is  as  follows:  "A  ball  thrown  on 
a  horizontal  plane,  strikes  another  ball  which  is  in  repose ;  this  latter 
moves  immediately.  The  impulse  of  the  first  will  be  regarded  as  the 
cause  of  the  movement  of  the  second.  However,  the  mind  does  not  per- 
ceive any  necessary  connection  between  the  two  phenomena  ;  but  their 
constant  succession,  which  inanifests  itself  every  time  that  we  renew  the 
experiment,  leads  us  to  believe  that  these  phenomena  succeed  each  other 
because  they  are  linked  together.  This  is  empirical  knowledge  and 
certainty."  Well  then,  I  again  ask,  what  difference  is  there  between 
the  proceeding  of  the  player  who  moves  one  ball  by  the  other,  and  that 
of  the  surgeon  who  reduces  a  luxated  bone  by  bringing  into  play  the 
muscular  forces,  in  an  inverse  direction  to  that  of  the  forces  which  pro- 
duced the  luxation  ?  Absolutely  none.  The  processes  are  the  same, 
and  the  certainty  exists  in  the  same  degree.  But  remember  the  fright 
of  Ambrose  Pare,  during  an  entire  night,  when  he  had  ligated  an  artery 
for  the  first  time  in  order  to  arrest  hemorrhage  after  an  amputation, 
and  then  tell  me  if  this  proceeding,  which  appears  to  us  to-day  so 
rational,  was  judged  so  then  by  that  celebrated  surgeon  ? 

We  conclude  from  this,  that  the  surgeon  who  reduces  a  luxation  or 
ligates  an  artery,  conformably  to  the  rules  of  his  art,  does  not  act  with 

^  Essai  de  Philosophic  Medicale,  p.  309. 


642  APPENDIX. 

more  reason  than  the  physician  who  administers  a  suitable  dose  of 
sulphate  of  quinine  to  a  person  attacked  with  intermittent  fever,  or  he 
who  vaccinates  a  child  to  protect  it  from  small  pox.  The  actions  of  both 
are  based  upon  a  perfectly  rational,  methodical  Empiricism.  If  so 
many  men  imagine  that  they  perceive  with  spiritual  eyes,  or  seize 
mentally  the  logical  connection  which  unites  the  act  of  the  surgeon  with 
the  effect  which  results  from  it,  while  they  avow  that  they  cannot  per- 
ceive any  rational  connection  between  the  act  of  the  physician  and  its 
result,  it  is  because  in  the  first  case  they  are  deluded ;  they  are  dupes 
of  that  faculty  of  the  human  understanding  which  Mallebranche  called 
folle  du  logis  (imagination)  as  Barthez  explains  very  well  in  the  following 
passage:  "  The  principle  of  motion  of  which  the  laws  are  most  simple, 
is  the  force  of  impulse.  The  action  of  this  force  seems  easy  to  under- 
stand, because  the  imagination  considers  motion  as  a  being  which  may 
communicate  itself  to  bodies  brought  into  contact  by  a  shock,  although 
it  cannot  overleap  any  intermediate  space.  However,  from  the  moment 
we  set  aside  this  false  view  of  motion,  the  force  of  impulse,  however 
simple  it  may  be,  i-emains  incomprehensible,  as  well  as  the  forces  of 
nature  which  follow  the  most  complicated  laws."  -  M.  Cousin  develops 
the  same  doctrine  in  terms  not  less  explicit,  f 

Hence  we  conclude  that  physicians  who  hope  to  found  their  curative 
indications  on  physio-pathological  facts  are  deceived  by  illusions  of  their 
imagination.  There  is  no  connection  perceptible  to  our  mind  between 
the  idea  of  a  disease,  however  complete  it  may  be  supposed,  and  the 
determination  of  the  curative  agent  applied  to  this  disease.  In  other 
words,  the  series  of  phenomena  which  constitute  a  pathological  state 
cannot  in  any  way  enable  us  to  foresee  the  succession  of  effects  which 
will  result  from  the  employment  of  this  or  that  mode  of  treatment, 
before  its  effects  have  been  observed  at  least  once.  Finally,  there  exists 
between  physiology  and  therapeutics  a  solution  of  continuity,  a  hiatus 
which  the  human  mind  can  overleap  only  by  the  aid  of  clinical  experi- 
ence, or,  in  other  words,  by  empiricism. 

However  paradoxical  this  doctrine  may  appear  to  a  large  number  of 
my  readers,  it  is  not,  however,  new.  It  goes  back,  on  the  contrary,  to 
the  infancy  of  the  Art.  It  presided  over  its  first  acquisitions.  It  is 
clearly  designated  in  two  books  of  the  Hippocratic  collection,  as  well  as 


'"'Nouveaux  Elements  de  la  Science  de  I'Homme,  chap,  iii,  tome  I,  page  49. 
•f  Cours  de  I'Histoire  de  la  Philosophie  Moderne.     Edition  1846,  tome  I,  pages 
247,  268. 


FOUKTH   LETTER.  643 

in  other  writings,  both  ancient  and  modern,  from  which  I  have  elsewhere 
quoted  extracts. 

But,  as  in  a  subject  so  delicate  and  important  we  cannot  multiply  too 
much  the  proofs  and  explanations,  no  one  will  find  fault,  I  think,  when 
I  add  some  other  fragments  of  cotemporary  authors.  "  If  by  motives, 
we  understand,"  says  M.  Louis,  "  that  any  remedy  whatever  ought  not  to 
be  employed  but  when  we  have  recognized  that  a  patient  is  in  the  situ- 
ation in  which  this  remedy  has  already  succeeded,  I  understand,  and  I 
agree  with  this  view — it  is  nothing  else  than  experience  applied  to 
therapeutics.  But  if  we  understand  by  motives,  as  by  indications, 
a  priori  considerations,  this  view  is  quite  hypothetical ;  it  enters  into 
so  called  rational  medicine,  experimental  medicine,  to  which  we  have 
recourse  only  when  in  want  of  a  better  system,  when  experience  has 
not  yet  spoken  ;  and  I  reject  it  with  all  my  powers. "=•■■= 

Hahnemann,  desiring  to  demonstrate  that  nosography  could  not  guide 
us  in  the  choice  of  remedies,  expresses  himself  thus  :  "In  general,  all 
science  whatever  can  judge  only  the  objects  belonging  to  itself.  It  is 
foolish  to  expect  from  it  instruction  on  subjects  belonging  to  other  sci- 
ences. =•'  =■■'  Xo  matter  how  necessary  it  may  be  to  the  agriculturist 
to  know  exactly  the  form  of  plants,  and  to  know  how  to  distinguish  them 
from  each  other  by  their  exterior  parts,  nevertheless,  botany,  which 
teaches  him  these  things,  can  never  teach  him  if  any  vegetable  is  fit 
food  for  his  sheep  or  hogs  ;  it  will  never  enable  him  to  know  what  kind 
of  grain  or  roots  gives  most  strength  to  the  horse,  or  fattens  cattle  best, 
Neither  the  systems  of  Tournefort  or  of  Linnaeus,  nor  the  method  of 
Haller  or  Jussieu  enlightens  him  on  this  point.  He  only  acquires  the 
knowledge  which  he  needs,  by  comparative  experiments,  made  with  care, 
on  difi"erent  animals,  "f 

Again,  the  historian  of  the  medical  doctrine  of  Montpellier,  Berard, 
says  that  "  Sauvages,  frightened  by  the  uncertainty  of  hypothesis, 
adopted  a  paradox  which  will  scandalize,  without  doubt,  the  systema- 
tists  of  all  tmes,  but  which  will  appear,  nevertheless,  incontestible  to  the 
physiologists  of  all  sects,  whenever  their  particular  opinions  are  not  in 
question."!  Physiology,  according  to  him,  connot  serve  as  a  primary, 
fundamental,  and  unique  basis  for  practical  Medicine. 

The  same  historian,  after  having  exposed  at  great  length  the  scien- 
tific economy  of  Empiricism,  sums  up  his  opinion  on  it   as  follows : 

■'  Memoires  de  la  Societe  Medical  d'Observation,  tome  I,  page  42. 

t  Traite   de   Matiere    Medicale.      Prolegomenes,   tome  I,    page  23,    trad  de 

Jourdan. 

I  Doctrine  Medicale  de  L'Ecole  de  Montpellier:  edition  de  18-16,  page  47. 


644  APPENDIX. 

"■  Empiricism  is  the  most  profoundly  elaborated  system  whicli  has  over 
appeared  in  Medicine,  and  merits  the  most  to  be  studied  with  care ;  it  is 
the  one  whose  contemplation  promises  to  the  philosophic  mind  the  most 
useful  and  fruitful  results,  and  can  serve  best  in  the  research  of  proper 
methods  to  satisfy  the  future  progress  of  the  science."  '••■' 

§VI.     CoNCLusioy. 

We  have  now  arrived,  basing  all  we  have  said  on  philosophic  axioms 
universally  admitted,  to  the  demonstration,  henceforth  immovable,  of 
this  great  truth  :  Neither  physiology  nor  pathology,  whatever  develop- 
ment they  may  acquire,  can  ever  serve  as  a  primary  and  immediate 
foundation  for  therapeutics.  There  is,  and  there  always  will  be, 
between  the  knowledge  of  a  disease  and  the  determination  of  the  appro- 
priate treatment,  an  interval,  a  void,  which  the  human  mind  can  fill  but 
by  the  aid  of  experiment. 

By  this  demonstration  we  have  set  aside,  not  only  all  the  systems  of 
Medicine  known  until  the  present  time,  which  ai'c  derived  from  some 
physio-pathological  idea,  but  all  those  also,  which  any  one  can  be 
tempted  in  the  future  to  extract  from  the  same  source.  We  have 
reestablished  practical  medicine  upon  a  true  and  primary  basis — clinical 
experience  ;  not  that  blind  and  limited  experience  of  the  first  age  of  the 
science,  but  an  analytical  and  learned  experience,  which,  collecting  with 
equal  care  the  old  traditions  and  new  acquisitions,  elucidates  them  both 
in  the  light  of  a  severe  critic. 

Nevertheless,  it  is  not  sufficient  to  have  recovered  and  set  forth  the 
true  foundation  of  therapeutics ;  it  is  still  necessar}'  to  demonstrate  that 
upon  this  foundation  we  can  and  ought  to  raise  the  entire  scientific 
edifice  of  Medicine.  It  is  necessary  to  prove  that,  far  from  rejecting,  as 
has  been  believed  for  a  long  time,  the  lights  of  anatomy,  physiology, 
pathology,  physics,  chemistry,  and,  iu  a  word,  all  the  branches  which 
are  connected  with  the  medical  encyclopedia,  rational  Empiricism,  or 
Empiri-methodism  is  the  only  one  of  all  the  systems  which  uses  them 
appropriately,  and  circumscribes  them  in  their  legitimate  bounds.  It  is 
necessary  to  demonstrate  that  it  is  the  only  system  which  ofi'ers  to  the 
practice  of  the  Healing  Art  an  immovable  basis — and  yet  sufficiently 
accommodating  to  receive  all  ulterior  improvements  ;  that  it  is  the  only 
one  which  does  not  reject,  a  priori,  any  means  of  treatment — neither 
doses  excessively  small,  nor  imponderable  fluids,  from  whatever  source 
they  may  come  ;    that  it  demands  of   the  most  extraordinary  thera- 

*'  Doctrine  Medicale  d'Ecole  de  Moutpcllicr ;   edition  1836,  page  424. 


FOURTH  LETTER.  645 

':>s         peutical   processes,  in  order  to  open  to  them  the  sanctuary  of  science. 

only  the  sanction  of  reiterated  proofs,  serious  and  sufficiently  con- 
J  ••  stant  in  their  results.  It  is  finally  necessary  to  prove  that  Emperi- 
rpa    '     methodism  is  the  only  one  of  all  the  systems  of  Medicine  which  resolves 

in  a  satisfactory  manner,  this  great  problem,  declared  insoluble  even  in 

our  times,  by  men  of  high  reputation  :     "  7^ he  harmony  of  science  ivith 

art — of  theory  tcith  practiced  -'^ 

But  before  undertaking   this  demonstration,  it  is  useful  to  refute 
L-    ■      specially  some  more  recent  medical  doctrines,  which  might  deceive  a 
^  I    \      large  number  of  our  readers. 


.  [• 


''  Consult,  among  other  writings  proclaiming  the  insolubility  of  such  a  prob- 
lem, the  feuilleton  of  the  Union  Medicale,  from  p.  24  to  27.    February,  1847. 


646  APPENDIX. 


FIFTH    LETTER. 

ON     ECLECTICISM     IN     MEDICINE. 

§  I.    Origin    of    the    New  Eclecticism    in    Medicine — Its    Difference    from 
Eclecticism    in    Philosophy. 

No  sooner  has  a  philosophic  doctrine  ohtained  any  celebrity  than  it 
is  reflected  in  Medicine.  This  is  a  fact  that  the  history  of  our  science 
confirms  at  each  step,  and  of  which  the  new  medical  Eclecticism 
oifers  one  more  sample.  It  is  about  thirty-five  years  since  a  young  pro- 
fessor of  philosophy  began  his  teaching  by  a  kind  of  protestation  against 
all  systems  of  metaphysics  which  derive  from  a  single  faculty  of  the 
human  understanding,  all  the  acquisitions  of  science.  He  tried  to 
demonstrate,  contrary  to  the  general  opinion  of  the  French  philosophers 
toward  the  end  of  the  eighteenth  century,  that  Sensitism  or  Empiricism 
show  us  only  one  side  of  things — the  material  or  sensible  side — and 
developes  in  us  but  a  single  order  of  ideas — the  contingent  ideas. 

He  proved  equally,  that  Spiritualism,  or  pure  Eationalism,  shows  only 
another  side  of  things — the  immaterial,  or  the  one  imperceptible  by  the 
senses — and  produces  in  us  but  a  single  order  of  ideas — the  necessary 
and  universal  ideas.  M.  Cousin  has  always  continued  in  this  path,  and 
by  his  influence  Eclecticism  has  become,  in  France,  quite  a  fashionable 
doctrine. 

About  the  same  epoch,  a  professor  of  Medicine  at  the  military  hospital 
of  Val-de-Grace  put  forth  a  system  in  which  all  diseases  are  represented 
as  an  effect  of  irritation,  as  a  simple  mode  or  a  transformation  of  phlogosis. 
This  system,  owing  to  the  favorable  disposition  of  the  minds  of  the  profes- 
sion, advantageously  prepared  by  the  philosophy  of  Condillac  and  of 
Cabanis,  who  also  considered  all  the  acts  of  the  understanding  as  a  result 
of  transformed  sensation,  took  a  rapid  growth,  and  in  less  than  ten  years 
became  common  in  France,  and  spread  over  Europe.  But  while  the 
physio-pathological  system  of  Broussais  reached  with  so  much  prompti- 
tude the  zenith  of  its  renown,  a  doctrine  more  modest  raised  itself 
slowly  by  the  side  of  it,  and  began  its  ruin. 


FIFTH    LETTER.  647 

Medical  Eclecticism,  the  emanation  of  philosophic  Eclecticism,  had 
already  protested  against  the  pretention  of  deducing  all  the  morbid 
phenomena  from  a  single  lesion.  It  collected,  by  the  aid  of  clinical 
observation,  pathological  anatomy,  and  chemical  analysis,  a  mass  of 
proofs  before  which  fell,  very  soon,  the  brilliant  edifice  of  the  professor 
of  Val-de-Grrace.  This  result  is  now  consummated.  For  some  years 
past  the  greater  part  of  our  writers  in  Medicine  profess  an  avowed  or 
tacit  Eclecticism,  as  we  have  seen  in  the  preceding  letter. 

All  have  renounced  the  idea  of  connecting  the  innumerable  anomalies 
of  the  living  organism  with  a  single  primitive  modification.  It  is,  then, 
essentially  important  in  the  present  medical  generation,  to  be  fixed  on 
the  value  of  Eclecticism  in  Medicine.  It  is  for  this  reason  that  we  have 
believed  it  our  duty  to  submit  this  doctrine  to  a  special  examination : 
and,  in  the  first  place,  we  intend  to  find  out  in  what  Medical  Eclecti- 
cism differs  from  philosophical  Eclecticism,  a  circumstance  which  does 
not  appear  in  anywise  to  have  entered  the  minds  of  our  Medical 
Eclectics. 

Philosophy,  embracing  the  entire  circle  of  human  acquirements, 
admits,  generally,  of  two  modes  of  acquisition,  known  under  the  names 
Rationalism  and  Empiricism.  The  first  consists  in  establishing  evi- 
dent principles,  or  axioms,  and  deducing  consequences  and  particular 
applications.  This  is  the  process  of  deduction.  This  mode  of  acquisi- 
tion, called  very  improperly,  by  certain  authors,  the  synthetical  method, 
is  more  especially  used  in  mathematics,  metaphysics,  morals  and  dia- 
lectics. The  second  mode  consists  in  studying  at  first  particular 
facts,  and  abstracting  what  they  have  in  common,  in  order  to  form  gen- 
eralities or  communities,  which  are  named,  also,  principles  and  axioms, 
because  these  generalities,  once  established,  guide  us  in  the  research  or 
production  of  other  particular  facts  like  the  first.  This  is  the  method 
of  induction.  This  mode  of  acquisition,  called,  sometimes,  wrongly,  the 
analytical  system,  is  employed  in  preference  by  naturalists,  natural 
philosophers,  chemists,  physicians,  etc.  In  Kationalism,  the  principle 
governs,  is  fixed ;  the  fact  is  subordinate,  variable.  In  Empiricism, 
on  the  contrary,  the  fact  governs,  and  it  must  be  constant,  and  well 
determined ;  the  principle  is  subordinate,  variable. 

We  may  conceive,  from  this  succint  expose,  that  the  philosopher 
can,  and  ought  even,  to  be  an  Eclectic  in  respect  to  methods,  that  he 
ought  to  give  the  preference  sometimes  to  one,  and  sometimes  to  the 
other,  according  to  the  order  of  facts  he  contemplates,  and  that  he  will 
do  wrong  in  adopting  one  exclusively,  on  all  occasions.  The  physician. 
on  the  contrary,  cannot  be  an  Eclectic,  since  he  has  no  choice  to  make 
in  this  respect.     The  method  which  he  ought  to  employ  habitually,  is 


648  APPENDIX. 

fully  indicated  by  the  order  of  facts  he  cultivates.  These  facts  arising 
from  sensation  or  observation,  he  ought  then  to  have  recourse  to  the 
Sensitic  method,  otherwise  called  the  Empirical  or  Inductive.  Eclecticism 
in  Medicine  cannot  then  consist,  as  Eclecticism  in  philosophy,  in  the 
choice  of  this  or  that  mode  of  acquisition.  Eclecticism  in  Medicine  is 
more  confined ;  its  object  is  entirely  special,  as  we  shall  see  from  the 
exposition  which  will  be  made  shortly.  But  before  entering  on  this 
exposition,  it  was  necessary  to  establish  the  capital  diflPerence  between 
philosophic  Eclecticism  and  medical  Eclecticism,  so  that,  in  the  end  of 
our  discourse,  no  one  may  apply  indistinctly  to  the  former,  whatever  we 
shall  say  for  or  against  the  latter. 


§11.     Ox   Eclecticism   in   PATnoLOGT. 

It  has  been  said  many  times,  and  we  cannot  repeat  it  too  often,  that 
Eclecticism  is  a  doctrine  so  vague,  so  undeterminate,  and  so  variable, 
that  no  one  has  dared  until  the  present  time,  to  give  a  complete  dog- 
matic exposition  of  it.  I  do  not  know  of  but  one  serious  attempt  of 
this  kind ;  it  was  made  by  one  of  the  most  eminent  medical  writers  of 
the  periodical  press.  M.  Jules  Guerin  addressed,  in  1831,  to  the  Koyal 
Academy  of  Medicine,  a  memoir,  in  which  he  treated  exclusively  of 
Eclecticism  in  pathology ;  at  the  same  time,  he  promised  a  second,  in 
which  he  would  treat  of  Eclecticism  in  therapeutics  ;  but  this  one  has 
never  yet  appeared,  and  according  to  all  appearances,  it  will  never  see 
the  light  of  day. 

However  this  may  be,  we  are  happy  in  possessing  the  work  of  M. 
Guerin,  by  the  aid  of  which,  it  will  be  possible  for  us  to  seize  this  pro- 
tean and  parasitic  doctrine,  which  lives  by  borrowing,  having  produced 
nothing  until  the  present  time,  in  itself,  but  an  individual  critic,  more 
or  less  independent  and  arbitrary.  This  is  the  opinion  of  the  author 
himself  whom  we  have  cited,  and  it  is  to  put  an  end  to  this  sterile  anar- 
chy of  Electicism,  to  constitute  it  dogmatically,  that  he  prepared,  he 
said,  his  memoir,  the  first  of  a  series  of  other  works  which  would  have 
the  same  aim.-' 

Consecjuently,  the  first  thing  that  M.  Guerin  proposes  to  decide,  in 
order  to  raise  the  scientific  edifice  of  Eclecticism,  is  the  instrument  or 
method  by  means  of  which  the  Eclectic  can  discern  the  true  from  the 
false,  the  real  from  the  hypothetical,  among  the  facts  and  opinion? 
which  are  furnished  by  other  systems.     Now,  this  writer  arrives,  by  a 

^  Memoire  sur  I'Electisisme  en  Medecine,  par  J.  Guerin,  page  2,  23,  and  26. 


FIFTH   LETTER.  649 

series  of  considerations,  to  the  conclusion,  that  the  supreme  criterion  of 
the  Eclectic  in  the  selection  of  his  materials,  is  nothing  else  than  expe- 
riment. From  which  it  results,  according  to  his  avowal,  that  Eclecti- 
cism confounds  itself  with  Empiricism,  in  respect  to  method. 

Some  persons  have  said,  he  says,  and  others  may  still  say,  that  Eclecti- 
cism, as  thus  determined,  is  only  the  experimental  method,  applied  to  Medi- 
cine, and  might  ask,  why  change  the  name  of  this  method  ?  Why  call  Ec- 
lecticism by  that  which  could  be  more  clearly  designed  under  the  name  of 
Experimentalism  ?  I  have  a  peremptory  answer  to  make  to  this  objection. 

I  will  give  this  answer  textually  :  "  Empiricism  is,  properly  speaking, 
the  chaos  of  science ;  I  may  dispense  with  showing  its  insufficiency. 
Empiricism  stops  at  those  facts  which  are  the  most  material ;  it  does 
not  regard  either  the  coiJrdination  of  facts,  or  the  explanation  of  the 
laws  which  produce  them ;  consequently,  it  rejects  science.  Its  obser- 
vation is  isolated  in  the  individuality  of  each  disease,  no  regard  being 
had  to  what  is  expressed  by  its  general  relations.  However,  if  it  does 
not  seek  analogies,  if  it  neglects  differences,  its  observation,  instead  of 
being  analytical,  is  superficial  and  general,  and  although  it  does  not 
approach  facts  with  preconceived  ideas,  it  sees  only  an  obscure  totality, 
and  its  experience  is  of  no  benefit  for  the  future." 

When  did  M.  G-uerin  find  that  Empiricism  does  not  require  either  co- 
ordination of  facts,  or  science  ;  that  it  does  not  seek  analogies  ;  that  it 
neglects  differences,  etc.  ?  Is  it  in  the  writings  of  the  ancient  or  mod- 
ern Empirics,  that  he  has  collected  such  maxims  "? 

Have  not  the  ancient  Empirics  established  excellent  precepts  to  dis- 
cern morbid  species?  Are  not  their  symptomatic  assemblages  the  most 
reasonable,  so  far  as  pathological  descriptions  are  concerned,  which  anti- 
quity has  transmitted  to  us  ?  Now  how  could  any  one  range  diseases 
into  classes  more  or  less  natural,  without  taking  into  account  their  ana- 
logies and  difi"erences — without  analysing  them  ? 

As  to  the  modern  Empirics,  it  sufl&ces  to  observe,  in  order  to  absolve 
them  from  the  incredible  accusations  with  which  they  have  been  charged 
in  the  description  above,  that  it  is  in  accordance  with  their  principles, 
as  proclaimed  by  Sydenham,  that  most  of  our  nosologies  are  composed. 

By  this  portrait  of  Empiricism  who  could  recognize  the  learned  sys- 
tem of  which  Baglivi  has  spoken  :  "  That  it  is  the  fruit  of  method  ele- 
vating itself  to  the  highest  truths  by  the  attentive  and  persevering  ob- 
servation of  phenomena ;  that  it  has  obtained  in  all  times  the  approba- 
tion of  distinguished  men,  Avho  were  forced  to  enlarge  it,  as  a  mode  of 
acquisition  conformable  to  our  nature."" 

*  De  Praxi  Medica,  Lib.  i.,  cap.  11. 
41 


650  APPENDIX. 

Could  you  recognize  it  yet  as  that  system  which  Berard,  the  historian 
of  the  doctrine  of  Montpellier,  regarded  as  the  most  profoundly  elabo- 
rated that  has  ever  ajipeared  in  Medicine.  Could  you  recognize 
in  it  the  philosophic  method  which,  according  to  M.  Cousin,  Bacon, 
Locke,  Hume  and  Condillac  have  developed  ?  '■'  No,  certainly  not. 
Empiricism,  such  as  is  represented  above,  is  neither  a  system 
nor  a  method  ;  it  is,  to  make  use  of  the  language  of  M.  Bouillaud, 
"  I  know  not  what,  which  has  no  name  and  does  not  merit  our  atten- 
tion here." 

M.  Guerin  is  perfectly  right  in  rejecting,  with  all  his  powers,  an  em- 
piricism so  gross,  and  so  anti-methodic  as  that  which  he  has  painted  for 
us.  But  is  it  loyal,  is  it  worthy  for  a  mind  so  elevated  as  his,  to  tra- 
vesty thus  the  opinions  that  he  wishes  to  refute  ?  Such  was  doubtless, 
not  his  intention.  He  has  been  led  by  the  habit  which  we  have  all  con- 
tracted, in  our  medical  education,  of  considering  empiricism  but  from 
its  bad  side,  and  in  its  lowest  representatives  ;  a  habit  which  makes  us 
confound,  sometimes,  scientific  Empiricism  or  Empiri-methodism,  with 
something  which  has  no  rank  in  science;  the  charlatanism  of  the 
mountebank,  ignorance,  the  denial  of  all  kinds  of  reasoning,  of  all  the- 
ory, of  all  methodic  co-ordination. 

What  proves  that  he  has  acted  in  this  way,  is  that  the  author  of  the 
memoir  in  favor  of  medical  Eclecticism,  wishing  to  characterize  a  little 
more  his  method,  and  to  render  it  unlike  those  of  other  systems,  ex- 
presses himself  in  these  terms :  "  The  observation  of  Eclecticism  is  sep- 
erated  equally  from  the  passive  neutrality  of  Empiricism  and  the  par- 
tial activity  of  systems.  It  applies  the  experimental  method  to  each 
fact ;  that  is  to  say,  it  notes  successively  all  the  elements  of  the 
facts,  accordingly  as  they  are  produced,  and  in  the  order  that  they  are 
produced.''  f 

For  myself,  I  confess,  the  more  I  study  the  method  counseled  and  des- 
cribed by  M.  Gruerin,  the  more  I  find  it  identical  with  that  of  Empiri- 
cism.    I  see  no  difference,  absolutely,  but  in  name. 

It  remains  to  ascertain  which  of  the  two  appellations  is  the  most 
exact,  his  or  ours.  In  this  respect  I  believe  that  M.  Guerin  has  himself 
decided  the  question,  in  giving  to  his  method  the  epithet  Experimental, 
synonyme  of  empiric.  At  the  most,  I  felicitate  myself  in  not  disagreeing 
with  him,  but  in  the  meaning  of  a  word.  When  we  have  reached  this 
point  we  are  not  far  from  understanding  each  other. 

'^  See  our  Fourth  Letter. 

f  Essai  sur  la  Philosophic  Medicale. 


FIFTH   LETTER.  651 

§111.     On    Eclecticism    in    Therapeutics. 

Eclecticism  in  therapeutics  consists,  as  we  have  said  elsewhere  :  First, 
in  not  admitting  any  universal  principle  of  treatment ;  second,  in  de- 
ducing the  curative  indications,  either  from  physio-pathological  theo- 
ries, or  from  pure  experi.acntation. 

Now,  we  have  proved  in  the  preceding  letter  that  it  is  impossible  to 
deduce  any  rule  of  cure  directly  from  pathological  physiology.  Conse- 
quently, we  might  ('ispense  with  a  more  ample  emamination  of  Eclecti- 
cism in  therapeutics  ;  because,  whoever  has  followed  our  argument  must 
have  seen  that  this  doctrine  is  fundamentally  erroneous.  But  there  are  so 
many  varieties  of  eclecticism  in  Medicine  that  this  refutation  en  ma&se 
does  not  suffice  ;  because  a  great  many  theories,  thoroughly  eclectic,  are 
produced  under  other  denominations,  and  every  one  does  not  perceive  at 
the  first  view  the  connection  which  exists  between  the  most  elevated 
principles  of  science,  and  their  remote  consequences.  Moreover,  this 
doctrine  is  the  most  fashionable  one  of  the  present  day,  and  in  this  view 
merits  still  on  our  part  a  special  examination. 

I  choose  designedly,  for  the  immediate  object  of  this  discussion,  one 
of  the  most  recent  and  most  remarkable  specimens  of  modern  Eclecti- 
cism, the  introduction  to  the  Treatise  on  Therapeutics,  by  MM.  Trous- 
seau and  Pidoux,  third  edition.  No  one,  I  hope,  will  accuse  me  of  con- 
sidering Eclecticism  in  its  lowest  representatives.  The  fragment  of 
medical  philosophy  which  I  have  just  designated  is  really  an  eclectic 
production,  although  its  authors  do  not  say  so  ;  but  I  judge  it  by  the 
maxims  which  are  emitted  in  it,  and  the  spirit  which  pervades  it  from 
the  beginning  to  the  end. 

Indeed,  after  a  rapid  description  of  the  revolution  that  the  expe- 
riments 01  Haller  on  irritability  of  the  tissues  first  introduced  into 
physiology,  and  consecutively  into  therapeutics,  after  a  succinct 
discussion  of  the  principal  doctrines  which  have  prevailed  since  the 
time  of  Cullen  till  our  day,  these  authors  begin  the  explanation  of 
their  own  theory,  of  which  I  will  give  the  following  resume  :  There 
exists  a  class  of  diseases  arising  from  a  simple  exaltation  or  depression 
of  the  vitality  of  the  organs.  These  diseases  have  no  real  specificity. 
and  do  not  differ  from  each  other  but  in  their  seats  and  degrees  of  inten- 
sity. They  are  not  diseases,  properly  so  called,  they  are  Occidents, 
purely  traumatic  lesions.  In  these  kinds  of  affections  there  is  no  neces- 
sity for  the  resources  of  the  Materia  Medica,  properly  so  called ;  the 
resources  of  hygiene  arc  sufficient.  In  this  numerous  class  of  diseases, 
the  curative  indications  ought  to  be  drawn  from  physio-pathological  ideas. 

Thci'e  is  another  class  of  diseases  whose  specificity  is  not  doubtful. 
Each  one  of  these  constitutes  in  the  organism  a  distinct  entity,  leading 


652  APPENDIX. 

in  some  sort  a  particular  life.  These  are  diseases  truly  essential, 
as  syphilis,  marsh  fever,  small  pox,  etc.  Against  this  class  of  affec- 
tions the  resources  of  hygiene  are  insufficient ;  we  cure  them  only  by  the 
aid  of  special  agents.  In  these  cases,  the  lights  of  pathological  physi- 
ology furnish  us  but  imperfect  indications ;  pure  experience  or  empiri- 
cism guides  us  more  surely. 

Such  is  the  doctrine  comprised  in  substance  in  this  essay  of  medical 
philosophy.  We  read  in  it  that  the  principle  of  general  therapeutics, 
the  sovereign  law  of  good  practitioners,  consists  "  in  the  idea  of  subor- 
dinating to  the  medication  of  the  symptom  that  of  the  morbid  unity, 
when  this  latter  is  not  well  determined  and  sufficiently  specific  to  gov- 
ern all  the  other  indications ;  and  to  subordinate,  on  the  contrary,  the 
medication  of  the  symptoms  to  that  of  the  nature  of  the  disease,  when 
this  latter  possesses  such  unity  and  such  specificity  that  none  of  its 
parts  or  its  symptoms  can  be  detached  from  it,  and  each  one  of  them 
represents  and  manifests  it  as  well  as  the  whole."* 

All  this  is  not  very  clear,  but  by  the  aid  of  the  antecedents  we  may 
^nevertheless  satisfy  ourselves  that  the  authors  of  this  article  have 
wished  to  avail  themselves  of  physio-path ologism  and  empiricism.  They 
think  that  we  should  take  from  physio-pathology  the  therapeutics  of  the 
first  class  of  diseases,  and  from  common  experience  the  therapeutics  of 
the  second  class.  This  is,  as  any  one  can  see,  pure  Eclecticism,  if  any 
thing  ever  was.  It  remains  to  know  how  we  may  know  if  a  morbid 
case  belongs  to  one  or  the  other  of  these  two  nosological  classes.  It  is 
not  easy  to  solve  this  question  in  a  large  number  of  affections,  even  the 
most  simple.  Let  us  take,  for  example,  venereal  chancres,  situated  on 
the  external  organs  of  generation.  Before  laying  down  a  treatment 
appropriate  to  this  lesion,  it  will  be  necessary  to  decide  if  it  is  of  a 
physiological  natui-e,  or  of  a  special  essence.  Now,  if  you  interrogate  a 
partisan  of  Easori  on  this  point,  he  will  answer  by  saying  that  you  must 
treat  ulcers  with  hypostheijia,  or,  in  other  words,  by  lowering  vitality. 
If  you  consult  a  follower  of  Broussais,  he  will  affirm  that  you  have 
■nothing  before  you  but  a  product  of  ulcerous  irritation,  or  an  exaltation 
of  vitality.  Another  theorist  will  see  in  it  a  particular  virus,  or  an 
essential  affection.  By  what  rule,  I  demand  of  the  authors  of  this  phi- 
losophic pamphlet,  by  what  criterion  do  you  make  your  final  choice  ? 
You  have  nothing  else  than  the  therapeutic  proof,  that  is  to  say. 
Empiricism,  which  you  have  endeavored  to  avoid,  and  which  you  have 
previously  condemned. 

But  if  your  sovereign  lata  can  not  guide  us  in  a  case  so  simple  as  the 

'  "Page  28. 


( 


FIFTH   LETTER.  653 

preceding,  of  what  aid  will  it  be  to  us  when  we  have  to  deal  with  some 
of  those  complex  affections  which  we  encounter  frequently  in  practice, 
such  as  typhoid  fever,  cholera,  scrofulous  affections,  etc.  V  With  such 
a  guide,  we  must  stumble  at  every  step  against  some  insoluble  difficulty. 
You  have  foreseen  this,  and  stated  it  in  formal  terms,  when  you  say : 
"  We  do  not  know  any  disease  which  may  not  have  a  certain  unity,  and 
may  not  be  distinguished  from  every  other  by  something  special. 
•-'  =-'  =-'  «  Just  as  wc  know  no  disease  which  does  not  remain 
subject  to  the  laws  of  the  economy,  and  which  does  not  consequently 
present  some  physiological  indications."" 

Thus  your  sovereign  laio  of  good  practitioners,  which  is  based  solely 
on  the  distinction  of  diseases  of  a  special  nature  from  diseases  of  a  phy- 
siological nature,  according  to  your  own  confession,  crumbles  to  its  very 
foundation.  I  will  not  stop  to  discuss  the  axiom  of  contraries,  although 
you  assert  that  it  is  at  the  present  time  better  demonstrated  than  ever 
before.f  It  is  a  subject  of  which  I  have  disposed  elsewhere,  in  such  a 
manner  that  I  have  no  need  to  return  to  it.  But  what  astonishes  me  in 
the  last  place  is,  that  you  declare  afterward  that  no  one  can  base  the  Mate- 
ria Medica,  in  the  present  state  of  science,  upon  a  general  idea.|  Is  in 
your  opinion  the  axiom  of  contraries  no  general  idea?  And  your  sove- 
reign laio  of  good  practitioners,  is  it  not,  either,  a  general  idea? 

Thus  you  see  the  inconvenience  of  having  no  fixed,  determined  prin- 
ciple ;  you  are  drawn  necessarily  into  contradictions  from  which  all  the 
talent  in  the  world  cannot  extricate  3'ou.  The  philosophic  medical  essay 
of  which  I  have  just  given  you  a  short  and  incomplete  analj' sis,  offers  us  a 
remarkable  example  of  this  defect.  Xotwithstanding  the  incontestable 
sagacity  and  talent  of  these  authors,  and  the  profound  study  which  they 
have  made  of  the  vicissitudes  of  therapeutics,  within  half  a  century, 
the  absence  of  a  fixed  and  avowed  principle  gives  vagueness,  indecision, 
and  obscurity  to  the  whole  of  their  work. 


IV.  Conclusion. 
Eclecticism  in  Medicine,  whether  considered  in  its  foundation  or  in 
its  details,  is  a  doctrine  proven  to  be  sterile,  and  which,  under  the  pre- 
text of  holding  an  equal  balance  among  the  various  systems,  acts  only 
as  a  poor  amalgam  without  fixed  proportions.  It  is  an  individual  criti- 
cism calculated  at  most  only  to  destroy  some  errors,  but  incapable  of 
establishing  anything  stable ;  unable,  in  short,  to  create  but  doubt  and 
uncertainty ;  a  doctrine  essentially  transitory,  which  must  disappear  in 

^  Page  28.  f  Page  53.  J  Page  70. 


654  APPENDIX. 

the  presence  of  the  true  theory,  as  the  shadows  of  twilight  arc  scattered 
before  the  beams  of  the  risinar  sun. 


ON    HOMEOPATHY. 

PRELIMINARY   CON  SIDE  RATIONS. 

"  The  time  has  gone  by,"  truly  remarks  the  translator  of  the  works 
of  Hahnemann,  "  when  the  pleasantri'^s  relative  to  the  infinitisemal 
doses  can  be  regarded  as  good  arguments  against  homeopathy." ••'  We 
are  certainly  compelled  to  take  this  doctrine  into  serious  consideration, 
since  men  commendable  by  their  scientific  titles  and  medical  position, 
members  of  faculties,  hospital  physicians,  and  eminent  practitioners, 
have  embraced  it  and  become  its  public  defenders ;  since  journals  have 
been  established  and  societies  instituted  in  different  countries  to  make 
public  its  principles  and  practice.  Before  this  invading  propaganda  it 
is  not  permitted  to  any  man  clothed  with  the  medical  pri'^sthood,  and 
comprehending  the  dignity  and  importance  of  his  ministry,  to  remain 
indifferent ;  it  is  necessary  for  him  to  take  a  part  for  or  against  it,  and 
how  can  he  take  a  part  in  so  grave  a  question  without  a  preliminary  and 
searching  examination '? 

I  regret  that  no  one  of  our  academical  dignitaries  or  teachers  have 
charged  themselves  with  such  a  work  ;  it  would  have  been  more  perfectly 
accomplished,  and  especially  more  authoritative  than  my  effort.  Unhap- 
pily, none  of  our  distinguished  teachers  have  deigned  or  dared  to  enter  the 
list  openly  for  a  combat  with  the  partisans  of  this  new  gospel.  It  is 
true  that  a  long  time  past,  some  experiments  were  made,  but  these  exper- 
iments, now  almost  forgotten,  should  have  been  resumed  on  a  grander 
scale  by  different  therapeutists  ;  for  it  must  be  avowed  that  the  negative 
results  published  by  M.  Andral,  or  any  other  experimenter,  whoever  he 
may  have  been,  can  not  nullify  the  mass  of  positive  results  that  the 
homeopaths  pretend  to  oppose  to  them. 

Moreover,  what  can  we  answer  when  they  say  to  us,  your  so-called 
rational  ]Mcdiciuc  only  treats  more  or  less  subtily  on  the  evils  of  human- 
ity, but  it  does  not  teach  you  at  all  how  to  relieve  them.  The  most 
efficacious  means  possessed  by  the  Healing  Art,  specifics  which  accord- 
ing to  common  consent  pi'ocure  the  mildest,  promptest,  and  most  durable 
cases,  your  official  medicine  proscribes  as  much  as  possible  ;  it  excludes 
them  from  its  theory,  if  not  from  its  practice.  AVe,  on  the  contrary, 
come  to  teach  you  a  means  to  discover,  and  a  method  to  employ  these 

'  .Jourdan.     Preface  to  French  translation  of  the  Treatise  on  Materia  Medica. 


FIFTH   LETTER.  655 

admirable  instruments  of  cure.  What  have  we  to  respond  to  such  an 
argumentation  ?     Nothing,  absolutely  nothing  serious  and  logical. 

There  is  not  one  among  the  old  doctrines,  except  rational  Empiricism, 
which  is  not  embarrassed  by  such  an  objection,  because  rational  Empiri- 
cism, or  Empiri-Methodism,  is  the  only  one  of  all  these  doctrines  which, 
far  from  excluding  from  its  theory  a  treatment  by  specifics,  admits  them 
on  the  contrary,  to  the  first  rank  of  curative  methods,  called  rational, 
as  may  be  seen  in  the  article  on  Therapeutical  Methods  in  the  Reform 
Period,  and  which  will  be  again  referred  to  in  its  appropriate  place. 

Since  our  masters  have  not  entered  into  a  struggle  with  the  apostles 
of  Homeopathy,  but  have  left  their  disciples  as  well  as  the  public  with- 
out a  guide,  and  without  defense  against  the  attractions  of  this  novelty 
and  the  deceitful  promises  of  these  innovators,  I,  though  an  obscure 
champion,  but  confident  in  the  principles  which  I  have  adopted,  will 
open  the  conflict,  by  exploring  to  its  most  minute  elements,  the  Homeo- 
pathic code. 


Philosophicax,  Phtsiological,  and  Pathological  Doctrine  of  Hahnemann. 


PHILOSOPHY. 


"The  mind  is  not  able  to  recognise  any  thing  aj)riori;  it  cannot 
form  in  itself  a  notion  on  the  essence  of  things,  their  causes  and 
their  effects.  Whenever  it  has  to  pronounce  truths  in  regard  to  real 
objects,  each  of  its  propositions  must  be  founded  on  sensible  observa- 
tions, on  facts  and  experience.  In  going  a  single  step  from  the  path  of 
observation,  it  is  at  once  plunged  into  the  illimitable  spaces  of  imagi- 
nation and  arbitrary  hypothesis,  parents  of  false  opinions  and  of  noth- 
ing absolute."-' 

These  are  maxims  which  a  pupil  of  Condillac  cannot  disavow.  They 
are,  indeed,  only  a  commentary  of  the  famous  axiom  of  the  Sensitist  or 
Empiric  school :  all  our  hwwlege  comes  from  the  senses  ;  an  axiom  which 
I  accept  not  as  of  universal  application,  but  limit  it  to  physical  sci- 
ences, of  which  ^Icdicine  is  one  of  the  most  eminent.  Thus,  then.  I  am 
in  harmony  with  the  pontiff  of  Homeopathy,  on  the  source  of  our  lights 
in  Medicine. 

PH  YS lOLOGY. 

•'  That  which  unites  the  living  parts  of  the  human  body  in  such  a 
manner  as  to  make  it  an  admirable  organism,  that  which  determines 
them  to  harmonize  in  a  manner  so  directly  contrary  to  their  primitive 

"Organon  De  I'Art  de  Guerir,  preface,  2d  edition,  French  translation  of  Bra. 
non,  p.  40. 


6S6  APPENDIX. 

nature,  physical  or  chemical,  that  which  animates  and  impels  them  to 
such  surprising  automatic  actions,  that  fundamental  force,  in  fine,  cannot 
be  represented  as  a  distinct  being ;  it  can  only  be  understood  imper- 
fectly ;  it  escapes  all  investigations,  and  all  our  perceptions.  No  mor- 
tal can  know  the  substratum  of  vitality,  or  the  disposition  a  priori  of 
the  living  organism.  No  mortal  can  sound  the  depths  of  such  a  sub- 
ject, nor  even  describe  its  shadow.  I^et  them  speak  in  prose  or  verse, 
human  language,  in  this  respect,  can  only  express  chimeras  or  nonsense. 

"  Consequently,  all  that  a  physician  can  know  of  his  subject,  the  liv- 
ing organism,  is  limited  to  what  the  sages  among  us,  a  Haller,  a  Blu- 
menbach,  a  Wrisberg,  have  understood  by  the  name  of  physiology,  and 
what  may  be  termed  experimental  biology ;  that  is  to  say,  appreciable 
phenomena  of  the  human  body  in  health,  separately  and  generally  con- 
sidered. The  impossible,  that  is  to  say,  how  these  phenomena  take 
place,  is  totally  excluded  from  the  circle  of  our  necessary  knowledge  in 
physiology."^;- 

This  profession  of  physiological  faith  has  no  need  of  comment.  It  is 
seen  that  its  author  only  admits,  in  the  science  of  life,  the  pure  and 
simple  description  of  phenomena  observed  during  the  natural  play  of  the 
organs,  or  those  excited  by  experiments.  This  is  still  Empiricism,  and 
the  most  austere  Empiricism,  I  will  even  say  the  narrowest.  For  the 
Empirical  doctrine,  well  understood,  in  all  the  breadth  of  its  principles, 
does  not  exclude  from  physiology  a  priori  consideration,  or  hypotheses  on 
the  organic  forces  and  the  substratum  of  vitality,  provided  that  these 
hypotheses  be  given  as  such,  and  not  for  realities ;  and  especially,  pro- 
vided, that  no  one  pretend  to  build  on  those  abstract  or  imaginary  enti- 
ties systems  of  Medicine  and  therapeutical  rules. 


PATHOLOGY. 


In  the  same  work,  Hahnemann  expresses  himself  in  these  words:  "  I 
pass  to  pathology,  in  which  the  same  furor  for  systems  which  turns  the 
brains  of  metaphysical  physiologists,  has  given  birth  to  so  many  hypothe- 
ses on  the  intimate  essence  of  diseases,  or  why  diseases  are  diseases  ;  in 
one  word,  on  what  is  called  the  proximate  or  interior  cause.  No  mortal 
has  a  clear  idea  of  what  is  sought  here.  "  •'  "  *  Nevertheless,  a 
crowd  of  sophists  have  affected  the  important  airs  of  men  who  possess 
this  knowledge.!" 

This  is  what  the  author  of  Homeopathy  wrote  in  1808,  before  he  had 

*  Valeur  des  Systemes  en  Medecine,  French  translation  of  Jourdan,  p.  462. 
t  Ibid.  p.  463. 


FIFTH   LETTER.  657 

promulgated  his  own  system.  The  following  was  published  in  his  Organon, 
in  1819  :  "  We  can  easily  conceive  tliat  each  disease  supposes  a  change 
in  the  interior  of  the  human  organism.  Nevertheless,  this  change  can 
be  suspected  only  in  an  obscure  and  dubious  manner,  by  the  symptoms 
of  the  disease ;  but  it  will  never  be  recognised  to  its  full  extent,  in  an 
infallible  manner."-' 

These  passages  and  a  groat  number  of  others  in  which  the  same  views 
are  held,  prove  that  Hahnemann  professed  in  pathology  as  in  physiolog}' 
and  philosophy  the  most  absolute  Empiricism  or  Sensitism ;  indeed,  1 
have  said  the  narrowest  and  most  exaggerated.  In  fact,  he  goes  so  far 
as  to  be  willing  to  expunge  from  medical  language  those  collective 
expressions  which  designate  a  concourse  of  symptoms  or  morbid  phenom- 
ena, such  as  pleurisy,  pneumonia,  tetanus,  diabetes,  hydropsy,  mania, 
angina,  phlogosis,  etc.,  under  the  pretext  that  these  words  are  not 
applicable  to  any  real  entity,  to  any  distinct  and  always  identical 
individuality.! 

But  can  any  one  mistake  to  such  a  point  the  most  elementary  princi- 
ples of  general  grammar  as  to  be  willing  to  banish  from  scientific  lan- 
guage abstract  terms,  because  these  terms  give  rise  often  to  very  differ- 
ent ideas  with  those  who  use  and  understand  them  ?  Thus  the  words 
pleurisy,  tetanus,  diabetes,  inflammation,  etc.,  have  extremely  varied 
significations,  not  only  in  pathological  treatises  belonging  to  difi'erent 
epochs,  but  even  in  those  of  the  same  epoch.  This  is  doubtless  a  fault, 
an  imperfection ;  but  this  fault  and  imperfection  are  common  to  all  the 
sciences  and  all  languages ;  they  are  inevitable. 

Do  the  names  of  the  classes,  orders  and  families  in  natural  history 
represent  real  objects  ?  Is  there  any  individual  in  the  vegetable  king- 
dom which  is  termed  acotyledon,  or  leguminous,  or  labiated  ?  Do  not 
these  several  words  express  an  abstract  collection  of  ideas  or  of  proper- 
ties common  to  a  multitude  of  different  vegetables  ?  Would  you  exclude 
from  philosophic  language  the  words  substance,  body,  spirit,  virtue, 
courage,  chastity,  vice,  etc.,  because  these  denominations  have  an  appli- 
cation to  nothing  material,  nothing  which  may  be  perceptible  to  the  sen- 
ses ;  because  they  awaken  sometimes  in  those  who  understand  them 
very  varied  ideas;  because,  in  fine,  there  are  ignorant  persons  who 
attribute  to  these  abstract  expressions  an  objective  reality? 

What  will  you  put  in  place  of  the  words  gastritis,  variola,  pneumo- 
nia, etc.,  which  you  would  exclude  from  pathological  language?     The 


'  Organon.    The  Art  of  Curing,  sec.  5. 
'  Ibid.     Section  83,  and  explanatory  note. 


658  APPENDIX. 

enumeration  of  all  the  symptoms  or  accidents  realized,  by  each  patient, 
responds  Hahnemann.  Thus  a  pure  homeopath  must  not  say,  for 
example,  I  treat  a  man  attacked  with  an  acute  articular  rheumatism. 
He  would  come  greatly  short  of  Hahnemannic  orthodoxy ;  but  he  must 
say,  I  treat  a  man  who,  in  consequence  of  taking  cold  has  been  attacked 
with  acute  pain  in  this  or  that  articulation ;  the  pain  is  exasperated  at 
certain  hours  in  the  morning  or  evening.  There  is  a  certain  degree  of 
swelling,  coloration,  etc,  ;  a  difficulty  or  complete  impossibility  of 
motion ;  so  many  strong,  slight  or  medium  pulsations  in  the  morning, 
at  noon  or  at  night,  before  or  after  meals,  etc.  The  patient  realizes  a 
vertigo  when  he  closes  his  eyes  at  five  o'clock  in  the  morning ;  his  head 
swims  when  he  looks  upward  after  drinking ;  there  are  sour  belchings 
after  eating  sour-crout,  etc,  etc.  The  stools  are  sometimes  green,  some- 
times gray,  sometimes  of  a  sour  or  putrid  odor,  etc.  etc.  He  has  itching 
of  the  nose  the  day  after  taking  a  cup  of  tea,  and  a  violent  itching  at 
the  anus  on  awaking  on  the  morning  of  the  fifth  day,  etc.  He  is 
inclined  to  anger;  sometimes  he  is  frightened  and  troubled  without 
cause,  and  a  thousand  similar  futilities. 

By  these  absurdities  Hahnemann  proposes  to  replace  the  usual  denomi- 
nations of  diseases  and  the  nosological  descriptions  of  authors.  I  am 
ashamed  for  the  enlightened  followers  of  Homeopathy  to  insist  on  the 
refutation  of  so  gross  a  philosophic  heresy,  which  several  of  them  have 
disavowed ;  but  I  am  forced  to  do  so,  because  it  constitutes  one  of  the 
foundations  of  the  mother  doctrine. 

It  may  possibly  be  objected,  that  Hahnemann  does  not  proscribe  the 
names  of  diseases  in  an  absolute  manner ;  that  he  even  tolerates  them  in 
common  language  in  the  presence  of  the  unprofessional ;  that  he  has 
even  employed  them  sometimes  in  his  writings.  Certainly  I  lose  nothing 
by  making  this  concession.  But  what  does  this  prove  ?  Nothing  else 
but  that  this  author  has  not  been  able  to  change  the  essence  of  human 
language  ;  that  he  has  been  constrained,  notwithstanding  his  obstinacy, 
to  express  himself  like  every  one  else.  It  is  a  law  which  no  man,  no 
Hahnemannic  Society  whatever,  can  ever  change  nor  disturb.  It  is  a 
specimen  of  folly,  or  alienation,  or  obstinate  ignorance  to  have  attempted 
not  to  conform  to  it,  and  so  directed  his  disciples. 

Nevertheless,  pathology  not  being  cultivated  with  any  particular  care 
by  the  founder  of  Homeopathy,  I  leave  this  branch  of  medical  knowledge, 
to  pass  to  therapeutics — the  true  battle  field  of  Hahnemann,  the  special 
object  of  his  meditations  and  researches. 


FIFTH   LETTEK,  659 


THERAPEUTICS     OP     HAHNgMANN. 


The  grand  axiom  of  Homeopathy,  the  one  from  which  the  doctrine 
takes  its  name,  is  this :  Cure  diseases  by  remedies  xvliich  'produce  symp- 
toms  similar  to  those  of  the  disease/' 

The  first  question  to  be  asked  after  reading  this  axiom,  so  contrary  to 
the  received  ideas  of  every  one,  the  learned  as  well  as  the  ignorant,  is 
this :  Where  has  the  author  obtained  his  therapeutic  rule  ?  On  what 
observations  and  experiments  does  he  found  so  paradoxical  a  proposition  ? 
I  have  sought  throughout  the  works  of  Hahnemann  for  a  clinical  obser- 
vation which  would  justify  his  famous  axiom,  and  I  avow  that  I  have 
not  been  able  to  find  a  single  one. 

Can  any  one  cite  as  medical  observations  worthy  of  any  confidence, 
such  remarks  as  the  following :  "  A  diarrhea  which  had  existed  for 
several  years,  and  which  threatened  an  inevitable  death,  against  which 
all  remedies  had  been  employed  in  vain,  was  cured  by  an  unprofessional 
practitioner  in  a  rapid  and  durable  manner  by  means  of  a  purgative,  as 
Fischer  observes,  to  his  great  astonishment,  but  not  to  mine.  "  "  * 
Boerhaave,  Sydenham  and  Eadcliif  were  able  to  cure  a  species  of  dropsy 
with  alder  blossoms,  simply  because  the  alder,  as  Haller  tells  us,  pro- 
duces tumors  (oedema)  by  its  external  application." 

"  How  many  times  does  not  the  small-pox  produce  deafness  and  dysp- 
noea ?  These  two  chronic  evils  were  therefore  extinguished  by  it,  when 
it  had  attained  their  highest  development,  as  I.  Fr.  Closs  has  remarked. 
o  o  o  Vaccination,  which  causes  as  its  proper  sign  a  tumor  on  the  arm, 
has  also  cured  after  its  eruption  a  swelled  and  nearly  paralyzed  arm."t 

If  it  is  by  observations  of  this  kind  that  Hahnemann  pretends  to 
prove  the  law  of  similars,  it  must  be  admitted  that  the  partisans  of 
Homeopathy  arc  not  hard  to  please  in  regard  to  proofs.  I  can  furnish 
them  with  another,  which  doubtless  escaped  the  erudition  of  their 
patriarch  :  The  son  of  Hemy  I.,  King  of  England,  having  been  attacked 
with  small-pox,  his  physician,  a  skillful  man  if  there  ever  was  one, 
ordered  with  all  convenient  ceremony  that  the  young  prince  be  enveloped 
in  scarlet;  that  everything  about  him  b3  red — the  hangings  of  his 
chamber  and  the  clothes  of  his  servants.  "  This  arrangement  cured 
him  so  well,"  he  says,  "  that  not  a  single  trace  of  the  disease  was  left 
upon  his  face."!  We  see  that  John  of  Gaddesdcn, — this  is  the  name 
of  the  celebrated  therapeutist — had  a  presentiment  of  Homeopathy  I 

Since  Hahnemann  is  contented  with  as  gross  analogies  as  those  above 

'^Organon,  sec.  1.5.  f  Organon,  §  41. 

;  Freind,  History  of  John  de  Gaddesden. 


660  APPENDIX. 

given,  it  was  not  difficult  for  him  to  demonstrate,  that  the  cures  of  all 
the  authors  that  history  has  transmitted  to  us  were  affected  in  the 
homeopathic  way.  Indeed,  where  is  the  remedy,  the  administration  of 
which  may  not  be  followed  by  one  or  two  symptoms  having  an  analogy 
more  or  less  remote  with  certain  morbid  symptoms,  especially  if  we 
relate,  like  Hahnemann,  to  the  action  of  the  remedy  all  the  grave  or 
slight  phenomena  which  manifest  themselves  for  ten,  twenty  or  forty 
days  after  its  administration  ? 

This  author  affirms  that  there  are  but  three  ways  of  employing  reme- 
dies specifically,  namely:  1,  The  Allopathic  method,  which  uses  reme- 
dies whose  effects  are  different  from  the  symptoms  of  the  disease.  2, 
The  Homeopathic,  which  employs  remedies  whose  effects  have  the  closest 
possible  resemblance  with  the  symptoms  of  the  disease.  3,  The  Anti- 
pathic method,  which  employs  remedies  contrary  to  the  disease. 

This  enumeration  is  not  complete,  and  there  should  have  been  added 
to  it,  for  gi'eater  exactness,  the  Isopathic,  which  consists  in  making  use 
of  means  identical  or  of  the  same  essence  as  the  disease,  such  as 
innoculation,  etc.  But  let  us  pass  over  this  omission,  to  which  I 
do  not  attach  much  importance.  There  is  another  much  more  capital 
reproach,  which  I  make  to  the  manner  in  which  the  action  of  curative 
agents  is  regarded  in  the  above.  I  say  that  this  manner  of  considering 
therapeutic  effects  is  radically  defective,  because  it  turns  the  human 
miml  from  the  true  object  of  the  Art,  to  enter  upon  researches  as  fruit- 
less as  insoluble. 

AVhat  is  in  fact  the  true  aim  of  therapeutics?  Is  it  not  to  cure? 
What  then  is  essentially  important  to  know  in  regard  to  any  remedy  or 
treatment  ?  Is  it  not  first,  if  it  cures ;  then  if  it  cures  promptly  and 
sui'cly.  Finally,  in  what  doses  and  in  what  morbid  circumstances  it 
shows  itself  most  efficacious.  Well  then,  in  what  way  can  one  be 
assured  incontestibly  of  all  these  things  ?  Is  it  not  by  means  of  thera- 
peutic proof  ?  Is  there  any  testimony  that  can  dispense  with  this  ? 
The  homeopaths,  the  allopaths,  the  antipaths  and  the  isopaths,  are  they 
not  all  obliged  to  appeal  to  this  criterion  and  submit  themselves  irrevo- 
cably to  its  sovereign  decision. 

When  therapeutic  proof  has  spoken,  what  is  the  use  of  enquiring 
if  the  remedy  has  acted  by  homogeneousness  or  by  antagonism,  by  sim- 
ilitude or  difference  ?  Is  not  this  a  vain  research,  since  it  can  neither 
replace  nor  impair  the  testimony  of  the  supreme  criterion  ?  Do  we  not 
arbitrarily  restrict  the  field  of  experimental  therapeutics  when  we 
include  it,  a  jfriori,  within  this  or  that  category  of  medicaments,  either 
heterogeneous  or  homogeneous,  homeopathic  or  allopathic  ;  or  when  we 
circumscribe  it  within  excessively  minute,  or  very  large,  or  medium  doses  ? 


FIFTH   LETTER.  661 

Most  writers  in  Medicine  resemble  the  attorneys  in  the  comedy  of  the 
Plaideurs,  who  speak  interminably  on  matters  foreign  to  the  case,  and 
say  nothing,  or  next  to  nothing,  on  what  concerns  the  litigation.  When 
any  one  has  made  experiments  with  a  remedy  or  a  treatment  in  a  cer- 
tain class  of  diseases,  he  describes,  as  briefly  as  possible,  the  character- 
istic symptoms  of  the  state  of  the  patient,  and  the  manifest  results  of 
his  experimentation,  but  dwells  at  great  length  on  the  presumed  or 
pathogenic  or  essential  cause  of  the  morbid  phenomena,  and  on  the 
intimate  modification  which  the  treatment  is  supposed  to  impress  on  the 
organism ;  things  entirely  imperceptible  to  the  senses,  and  on  which  our 
minds  can  form  only  ephemeral  conjectures.  We  know,  for  example, 
that  opium  generally  causes  sleep,  but  that  frequently,  also,  it  produces 
agitation.  This  double  effect  of  the  same  substance  has  put  to  torture 
the  minds  of  the  theorists  of  our  age.  They  have  written  a  thousand 
dissertations,  and  imagined  numerous  theories  to  explain  this  apparent 
anomaly,  without  advancing  the  question  one  iota.  Does  opium  possess 
sedative  or  exciting  properties  ?  Notwithstanding  our  progress,  and 
our  pretentious  physiology,  we  know  no  more  on  this  matter  than  did 
Gralen,  Avicenna,  the  Arabists,  and  the  scholastics  of  the  middle  ages. 
If  any  one  now  asks  why  opium  produces  sleep,  we  shall  not  be  able  to 
give  a  better  reason  than  that  in  Moliere:  "  Opium  facit  dormire,  quia 
in  eo  est  virtus  dormitiva."  Behold !  where  all  our  curious  researches 
on  objects  inaccessible  to  our  observation  lead  us,  and  cause  us  to 
neglect  the  essential  and  indispensable  ?  Instead  of  expatiating  learn- 
edly on  the  excitant  or  sedative  property  of  opium,  it  would  be  better — 
it  would  be  infinitely  more  useful — to  seek  out.  by  direct  and  con- 
tinued experiments,  what  are  the  conditions  of  health  and  disease  in 
which  this  substance  produces  a  sedative  effect,  and  what  are  the  condi- 
tions in  which  it  produces  an  opposite  one  ;  what  are  the  doses  and  the 
preparations  most  proper  to  bring  about  either  result. 

But  this  way  is  too  simple  and  too  long,  and  does  not  give  a  free  rein  to 
the  imagination.  Hahnemann  preferred  to  follow  the  beaten  path,  by  sub- 
stituting in  all  his  writings,  transcendental  explanations  for  clear  and 
established  experience.  In  justification,  for  example,  of  infinitesimal 
doses, instead  of  bringing  detailed  and  authentic  facts  of  curing  to  the 
support  of  his  method,  he  endeavors  to  persuade  you  by  an  inextricable 
tissue  of  subtile  devices,  that  diseases  being  only  immaterial  alterations 
of  an  immaterial  vital  principle,  must  be  combatted  by  forces  of  the 
same  nature — that  is  to  say,  by  the  spiritual  virtue  of  medicaments, 
developed   by  means  of  homeopathic  attenuation.-' 

*  Organ,  sections  53,  66. 


662  APPENDIX. 

Another  time  be  will  tell  you  that  the  general  forces  of  nature,  such 
as  attraction,  electricity  and  caloric,  whose  powers  are  manifest  to  every 
one,  are  neither  ponderable  nor  coercible ;  whence  he  infers  that  we  are 
wrong  in  doubting  the  efficacy  of  any  infinitesimal  doses  whatever. '••■^ 

This  proves  that  he  has  not,  then,  observed  that  if  the  forces  of  which 
we  have  just  spoken  are  imponderable  and  inaccessible  to  our  senses. 
their  substrata  are  not  at  all  so.  Thus,  the  force  of  attraction  is  in 
proportion  to  masses ;  electricity  is  developed  in  proportion  to  the  fric- 
tion of  surfaces ;  caloric  to  the  quantity  of  combustibles — all  of  which 
are  material,  and  appreciable  by  the  senses. 

It  is  known  that  Hahnemann  has  composed  a  treatise  on  ^Materia 
Medica  and  Chronic  Diseases,  in  which  he  attributes  a  multitude  of 
new  and  unheard-of  properties  to  several  substances  supposed  hitherto 
to  be  perfectly  inert.  He  assures  us,  for  example,  that  the  carbonate 
of  lime,  administered  in  doses  of  the  sixtiUionth  part  of  a  grain,  pro- 
duces no  less  than  one  thousand  and  ninety  symptoms,  from  among  which 
I  select  the  following :  f 

1.  In  the  evening  (thirteen  days  after  taking  it),  on  going  out. 
unsteady  gait. 

2.  Dizziness  on  walking  out  (at  the  end  of  twenty-six  days). 
14a.     Sudden  deafness,  immediately  after  dinner. 

147.     Itching  on  the  border  of  the  eyelids  (after  five  days). 

572.  Itching  at  the  anterior  part  of  the  glans  penis,  after  urination 
(after  twenty-eight  days). 

583.  Ardent  venereal  desires,  especially  during  a  walk  before  dinner 
(after  seventeen  days). 

865,  Great  heat  at  the  extremity  of  the  big  toe  (after  twenty-one 
days).  I 

Pray  tell  us  how  any  one  can  assure  himself  that  an  imperceptible 
atom  of  the  carbonate  of  lime  is,  unquestionably,  the  determining  cause 
of  these  thousand  and  ninety  symptoms,  a  great  number  of  Avhich  are 
manifested  only  at  the  end  of  ten,  twenty  and  thirty  days  after  the 
ingestion  of  the  medicamental  atom  ?  Who  can  assure  us  that  the  most 
of  these  strange  phenomena  that  are  attributed  to  the  influence  of  the 
infinitessimal  atom,  are  not,  rather,  the  effect  of  a  multitude  of  other 
forces,  quite  energetic,  on  the  contrary,  which  act  unceasingly  on  the 
economy — some  permanently,  others  accidentally?  Is  it  not  absurd,  as 
Hahnemann  himself  says,  elsewhere,  to  attribute  an  effect  to  one  force, 

^  Organon,  sect.  305,  and  note. 

f  The  figures  denote  the  order  in  which  the  symptoms  stand. 

\  Treatise  on  Chronic  Diseases. 


FIFTH    LETTER.  663 

while  there  are  in  play,  at  the  same  time,  other  forces  which  often  con- 
tribute more  than  it  to  its  production.- 

To  these  questions,  so  legitimate  and  ?o  pressing,  the  author  of 
Homeopathy  makes  no  response.  He  only  opposes  affirmations  destitute 
of  every  species  of  proof,  and  his  credulous  adepts  are  contented.  They 
accept  his  strangest  assertions  as  articles  of  faith.  Some,  however,  have 
separated  themselves  from  the  faithful  flock,  and  attempted  to  revise  the 
symptomatic  categories  of  Hahnemann.  They  have  submitted  each  of 
his  propositions  to  scrupulous  examination,  and  exact  experiments ;  and 
what  have  they  found  at  the  foundation  of  this  burlesque  frame,  pomp- 
ously announced  as  a  divine  revelation "?  I  will  let  one  of  the  admirers 
of  Hahnemann  make  the  reply. 

M.  Rapou,  historian  of  the  Homeopathic  doctrine,  in  summing  up. 
under  the  title  of  the  "  Specific  School,"  the  sum  of  the  differences  which 
are  exhibited  among  the  partisans  of  the  new  method,  expresses  himself 
as  follows :  "  The  law  of  similars  is  positive,  but  it  does  not  constitute 
the  general  law  of  therapeutics.  Medicamental  substances  may  operate 
by  the  law  of  contraries  ;  enantiopathy  is  as  often  in  play  as  homeo- 
pathy— both  are  secondary  and  accessory  modes.  The  great  principle 
is  the  specificity,  and  the  most  important  problem  is  not  to  seek  the 
similarity  between  the  remedy  and  the  disease,  but  to  find,  directly,  the 
specific  appropriate  to  each  morbid  state.  Dynamization  does  not  exist 
even  where  by  many  its  importance  has  been  greatly  exaggerated. 
Dilution  is  incapable  of  developing  a  medicamental  efficaciousness  in 
most  substances  which  are  inert  in  their  natural  state,  and  which 
Hahnemann  has  put  among  the  number  of  active  remedies.  Infinites- 
imal doses  have  no  marked  action ;  it  is  necessary,  ordinarih*,  to 
employ  tinctures  and  powders,  and  never  to  extend  them  beyond  the 
third  or  fourth  divisions.  Our  medicines  may  be  administered  with- 
out inconvenience  in  the  ordinary  pharmaceutical  preparations,  and 
the  various  allopathic  remedies  may  be  employed  conveniently  with 
them.  Clinics  must  become  the  principal  source  of  indications,  and 
concur,  in  the  largest  degree,  to  the  formation  of  our  pure  materia 
medica.  This  last  part  of  science  is  to  be  reconstructed ;  an  anatomical 
and  physiological  classification  of  symptoms  must  be  introduced  into 
it.  The  theory  of  psora,  and  its  pretended  consequences,  arc  false  in 
all  respects.  We  can  and  we  must  seek  to  combine  the  specific  proceed- 
ure  with  the  usual  indications.  It  is  proper  to  fall  back  to  the  use  of 
pharmaceutical  mixtures."  f 

^  Treatise  ou  Materia  Medica. 

■f  Histoire  de  la  Doctrine  Homceopathic,  1817 — vol.  II,  chap.  xit. 


664  APPENDIX. 

These,  then,  are  the  results  to  which  Hahnemann's  own  disciples  have 
arrived  when  they  endeavored  to  verity  by  facts,  the  astonishing  asser- 
tions of  their  master.  Each  one  of  the  fundamental  propositions  of  the 
new  doctrine,  receives  thereby  the  most  formal  denial.  What  remains 
of  this  doctrine  after  so  complete  and  detailed  a  refutation  ?  Nothing, 
absolutely  nothing  which  is  worthy  of  the  attention  of  a  man  of  sense. 

As  to  the  expose  of  principles  which  we  have  just  read,  and  which 
forms  the  programme  of  emancipated  Homeopathists,  under  the  name  of 
the  Specific  School  (Ecole  Specijicienne),  I  do  not  see  what  the  most 
severe  critic  can  find  to  condemn,  unless  it  be  the  words  specificity,  spe- 
cifics, which  might  be  advantageously  replaced  by  the  more  exact  expres- 
sions synthesis  and  synthetical.  Apart  from  this  slight  modification,  the 
programme  of  the  Specific  School  agrees  entirely  with  the  principles  which 
we  have,  ourselves,  proclaimed  under  the  head  oi Empiri-Methodic  system. 

CONCLUSION. 

The  Hahnemannic  doctrine,  whose  defects  we  have  only  feebly  set  forth, 
ofiers  to  us  the  strange  assemblage  of  assertions  devoid  of  proof,  auda- 
cious paradoxes  and  manifest  contradictions.  Its  author,  after  hav- 
ing declared  solemnly  in  numerous  passages  that  "  the  human  mind 
cannot  form  of  itself  a  notion  of  the  essence  of  things,  of  their  cause 
and  their  effects  ;  that  every  proposition  must  be  founded  on  sensible 
observation,  on  facts  and  experiments,"  forgets  the  maxims  of  his  wise 
philosophy,  when  he  is  laying  the  foundation  of  his  medical  system  and 
laboring  for  its  development. 

From  that  time  he  did  not  hesitate  to  affirm  that  all  the  chronic  dis- 
eases that  are  observed  in  Europe,  (except  syphilis,)  are  the  result  of 
a  protean  impalpable  miasm  which  he  calls  the  psoric  or  scabby.  If  a 
child  passes  worms  in  his  alvine  dejections  or  by  vomiting,  if  he  is  sub- 
ject to  opthalmia,  catarrh,  convulsions,  sore  throat ;  to  furuncular  tumors, 
scrofulous  engorgement,  etc ;  it  is,  according  to  Hahnemann  a  latent 
psoric  miasm  which  is  at  work.  If  a  young  girl  is  afi^"ected  with  chlorosis, 
or  hysteria  or  chorea  ;  if  she  is  subject  to  spitting  of  blood  or  threatened 
with  pulmonary  tubercles  or  aneurism  of  the  heart,  etc.,  etc.,  psora  is 
committing  in  her  these  ravages.  If  an  old  man  has  hemorrhoids  or 
tetters,  if  he  is  affected  with  a  catarrh,  or  an  asthma,  or  dropsy,  or  gout, 
or  rheumatism  or  paralysis,  etc.,  the  psoric  virus  manifests  in  him  its 
presence. 

By  what  series  of  transcendental  observations,  of  delicate  experiment, 
has  Hahnemann  been  able  to  grasp  and  unite  so  many  and  so  various 
phenomena  with  the  incoercible  and  immaterial  miasm  which  he  names 
psoric  virus.     He  is  silent  upon  this  subject,  which  is  incomprehensible 


SIXTH   LETTEK.  665 

and  incredible  to  whoever  does  not  possess  homeopatliic  faith  ;  but 
becomes  hicid  and  indubitable  to  those  who  possess  this  new,  pretended 
divine  revelation. 

An  orthodox  Homeopathist  is  very  careful  not  to  suspect  the  most 
unimaginable  assertion  of  his  prophet.  No  one  among  them,  for  example, 
has  ever  attempted  to  call  in  question  the  following  anecdote  by  which 
Hahnemann  pretends  to  prove  the  efficaciousness  of  his  infinitesimal 
doses :  "Let  a  melancholic  patient,  disgusted  with  life,  and  feeling  pressed 
by  an  insupportable  anguish  to  commit  suicide,  smell  for  several  minutes 
only,  a  flask  containing  a  quadrillion th  of  a  grain  of  homeopathic  powdered 
gold,  and  at  the  end  of  half  an  hour  he  will  be  delivered  from  the  demon 
which  seemed  to  possess  him,  and  his  flow  of  spirits  will  become  again 
like  that  of  a  man  of  sound  mind."-- 

No  founder  of  a  medical  philosophic  sect,  since  Pythagoras,  has  pushed 
as  far  as  the  chief  of  the  Homeopathists,  the  despotism  of  the  word  of 
the  master.  No  one  has  imposed  on  his  disciples  more  submissive  and 
blind  credulity.  In  order  to  demonstrate  the  reality  of  homeopathic 
cures  he  does  not  report  any  well  established  facts  or  observations,  he 
contents  himself  with  affirming  that  the  medicamental  atoms  given  to  his 
patient  proceed  to  the  imperceptible  point  of  the  economy  wiich  is  the 
seat  of  the  primary  lesion,  and  by  acting  upon  it  cause  the  disease  to 
cease,  naturally,  by  replacing  it  with  a  stronger  artificial  afi'ection,  which 
is  subsequently  extinguished  by  the  vital  force  ;  and  not  one  of  his  dis- 
ciples ask  him  how  he  has  been  able  to  perceive  all  these  phenomena, 
inaccessible  to  the  human  eye — how  he  has  been  able  to  follow  the  track 
of  the  infinitcssimal  atom,  the  course  of  which  he  recounts  with  so  much 
assurance  !  Oh,  Messieurs  Homeopathists,  you  merit  well  the  epithet  of 
Hahnemanni  servzim  pecus  ! 

'■'  Treatise  on  the  efficaciousness  of  minute  homeopathic  doses. 


42 


666  APPENDIX. 


SEVENTH   IE  TTER. 

THERAPEUTICAL    METHODS. 
I.     Present    State  of    this    Branch    of    Science. 

This  branch  of  the  science  is,  without  contradiction,  one  of  the  least 
advanced ;  only  a  few  feeble  gleams  of  light  pierce  the  thick  darkness 
that  envelopes  it.  The  classification  of  the  therapeutical  methods,  by 
Barthez,  which  I  have  previously  cited,  is  yet  the  best  and  most  rational 
that  we  possess."  However,  it  can  only  be  considered  a  rough  draft, 
because  it  partakes,  with  all  the  other  modem  therapeutical  classifi- 
cations, of  the  capital  fault  of  incoherence  and  inconsistency.  Thus  the 
classification  of  Barthez  admits  a  natural  method,  having  for  its  object 
to  favor,  accelerate,  or  regulate  the  progress  of  diseases  which  tend  to  a 
favorable  termination.  An  analytical  method,  in  which  each  disease  is 
decomposed  into  a  certain  number  of  elementary  afi*ections,  which  are  to 
be  treated  separately  by  appropriate  means ;  an  empirical  method,  by 
which  certain  maladies  whose  nature  is  unknown  are  combatted  with 
remedies  whose  immediate  or  primitive  action  is  not  understood  ;  finally, 
a  pcrturbative  method,  which  Messrs.  Trousseau  and  Pidoux  replace  by 
the  substitative  method.  Let  us  consider  the  incoherency  of  this 
classification.  The  first  method  is  called  natural ;  the  second  ought  to  be 
called,  by  way  of  opposition,  nmiatnral.  There  is  a  method  which  is 
designated  by  the  term  analytic  ;  there  should  be  one  called  the  syn- 
thetic. The  fundamental  rule  in  every  classification  or  division  of  an}- 
subject  whatever  is,  that  the  parts  of  which  it  is  composed  should  recip- 
rocally exclude  each  other,  but  this  rule  has  been  comparatively  forgot- 
ten, as  may  be  perceived  in  the  classification  of  Barthez ;  each  of  the 
methods  which  have  been  admitted  is  founded  on  considerations  of  an 
order  foreign  to  the  preceding,  instead  of  flowing  from  the  same  princi- 
ple, as  the  branches  of  a  tree  proceed  from  the  same  trunk.  What 
would  be  said  of  a  naturalist,  should  he  divide  bodies  into  artificial 
and  organic,  or  of  a  pathologist  who  should  divide  diseases  into  epi- 
demic, endemic,  and  contagious  ?     It  would  be  alleged  that  they  mix 

'-'  See  our  Third  Letter. 


SEVENTH  LETTER.  667 

and  confound  all  their  ideas.  Does  not  a  therapeutical  classification 
based  upon  diflferent  principles  merit  the  same  reproach  ?  The  incon- 
sistency of  the  classification  of  Barthez  is  not  less  palpable  than  its 
incoherence.  In  fact,  we  find  a  method  distinguished  from  the  others 
by  the  title  Empiric,  which  signifies,  in  the  ordinary  language  of  authors, 
unreasonable  and  unphysiological.  But  this  method  being  the  one 
which,  by  the  consent  of  eveiybody,  produces  the  most  brilliant  cures, 
it  follows  according  to  its  peculiar  denomination,  that  physicians  never 
produce  better  cures  than  when  they  treat  diseases  without  being  guided 
by,  or  even  contrary  to  their  theories.  What  beautiful  logic !  And 
yet  I  venture  to  say,  French  Medicine  has  not  produced  a  greater  genius 
than  Barthez.  But  what  can  you  expect ;  the  most  adroit  musician  can 
not  produce  harmonious  sounds  from  a  poor  instrument.  As  long  as  theo- 
rists shall  obstinately  designate  certain  curative  methods  by  titles  which 
are  appropriate,  or  ought  to  be  appropriate,  to  all  of  them  in  general ;  as 
long  as  they  will  continue  obstinately  to  call  the  one  rational,  the  other 
natural,  a  third  exact,  a  fourth  physiological,  another  experimental  or 
empirical,  etc.,  never,  no,  never,  will  therapeutics  escape  from  the  chaos 
into  which  it  has  been  plunged ;  never  shall  we  succeed  in  forming  a 
truly  rational  classification  of  the  different  modes  of  treatment. 

In  order  to  accomplish  an  object  so  desirable,  it  is  necessary  at  first 
to  establish  a  universal  principle  of  therapeutics,  embracing  all  the  ope- 
rations of  internal  and  external  Medicine ;  afterward,  to  deduce  from 
this  principle  the  diflferent  curative  methods  proposed ;  finally,  to  desig- 
nate each  of  these  methods  by  a  term  which  is  applicable  to  it  alone. 

We  have  already  fulfilled  the  first  of  these  conditions,  in  forming  the 
following  precept,  whose  evidence  and  generality  no  one  will  contest ; 
treat  each  malady  hy  those  means  xvliose  efficacy  in  similar  or  homologous 
cases  has  been  demonstrated  hy  experiences-  We  shall  now  attempt  to 
fullfil  the  other  two  in  the  classification  which  follows. 


§11.     Classification    of    the    Therapeutical   Methods. 

THE     SYXTHETICAL     METHOD. 

The  most  ancient,  the  most  natural,  and  the  most  simple  mode  of  cure 
consists  in  opposing  to  each  disease  which  presents  itself,  one  remedy  or 
one  combination  of  curative  means,  which  removes  the  disease  at  once. 
In  this  mode  of  treatment  our  mind  considers  all  the  symptoms  as  forming 

'"'  See  our  Second  Letter,  §  4  and  5. 


668  APPENDIX. 

an  indivisible  concourse,  as  tlie  manifestation  of  one  simple  morbid 
entity,  against  which  he  directs  a  plan  of  medication  which  seems  to 
attack  the  disease  in  its  essence,  and  to  put  an  end  to  all  the  accidents 
by  a  virtue  which  is  special  and  peculiar  to  it,  and  is  in  some  sort 
incomprehensible.  I  shall  give  to  this  method  the  epithet  synthetic ; 
that  is  to  say,  simultaneous,  a  word  which  represents  very  exactly  the 
manner  in  which  our  minds  consider  both  the  morbid  symptoms  and  the 
effects  of  the  treatment. 

The  ancients,  who  saw  in  all  cures  nothing  but  the  result  of  antago- 
nistic foi'ces,  designated  these  kinds  of  medication  by  the  name  of  anti- 
dotes, the  moderns  called  them  specifics.  By  a  sort  of  precipitation  very 
common  to  the  human  mind,  the  first  therapeutists  were  very  quick  to 
arrange  among  the  antidotes  a  larger  number  of  substances  whose  vir- 
tues were  by  no  means  assured.  Thus  they  designated  a  large  number 
of  plants  by  the  title  of  vulnerary,  because  they  supposed  them  to  pos- 
sess especial  virtue  in  the  cure  of  wounds.  They  called  theriacs  several 
very  complicated  pharmaceutical  preparations  which,  in  their  imagina- 
tion, had  a  marvelous  efiicacy  against  venom  and  all  sorts  of  poisons. 

It  is  the  same  with  a  multitude  of  pharmaceutical  affections  of  anti- 
quity. The  moderns  have  not  been  less  prolific  in  this  respect,  but 
have  often  been  less  sincere ;  and  the  pompous  denominations  by  which 
they  designate  numerous  medicaments  are  only  enticing  labels  to  attract 
customers.  Among  this  number  are  to  be  classed  the  elixirs  of  lon- 
gevity, of  immortality,  the  anti-goutous  and  anti-mucous  nervines,  the 
sedative  waters,  etc.  etc. 

Galen,  not  knowing  how  to  explain  the  therapeutical  effects  of  anti- 
dotes, has  said  that  these  remedies  act  hy  their  whole  substance,  and 
medical  posterity  has  repeated  this  explanation,  which  was  nothing 
more  than  a  method  of  concealing  its  ignorance :  in  the  same  way  natu- 
ral philosophers  concealed  their  ignorance  of  the  cause  of  the  ascension 
of  water  in  the  tube  of  a  suction  pump,  by  saying  that  the  liquid 
rises  in  consequence  of  nature's  horror  of  a  vacuum.  The  moderns, 
not  willing  to  be  satisfied  by  senseless  explications,  have  fallen  into 
excesses  not  less  ridiculous.  Some  have  denied  the  existence  of  specif- 
ics ;  others,  without  contesting  either  their  existence  or  admirable  effi- 
cacy, have  endeavored  to  proscribe  them,  or  to  restrict  their  application 
as  much  as  possible.  They  have  treated  these  remedies  as  irrational. 
They  have  banished  them  from  their  theories,  in  order  to  give  them 
over  to  blind  and  ignorant  practitioners.  I  have  demonstrated  the  error 
of  this  peculiar  prejudice,  but  it  cannot  be  too  much  denounced  for  the 
interests  of  humanity  and  for  the  honor  of  the  Medical  Art. 


SEVENTH    LETTEK.  669 

Too  fortunate  indeed  would  be  both  patients  and  pliysicians,  if  the 
occasion  more  frequently  presented  itself  in  which  we  could  employ  those 
remedies,  called  specifics,  or  better,  synthetics,  which  remove  a  disease  in 
totality  as  if  by  a  charm,  however  numerous  its  symptoms  may  be,  and 
whatever  mask  it  may  wear  !  The  day  is  not  far  distant  when  men  will 
be  astonished  at  the  resistance  of  my  cotemporaries  against  the  restora- 
tion to  the  method  which  I  call  synthetic,  the  title  of  rational,  which  it 
should  never  have  lost,  and  which  it  merits  in  the  highest  degree.  We 
do  not  ask  the  natural  philosopher  or  the  chemist,  why  alkali  combines 
with  an  acid ;  why  the  electric  spark  converts  the  mixture  of  hydrogen 
and  oxygen  gases  into  water.  We  do  not  ask  the  physiologist  why  the 
marsh  mallow  is  insipid  to  the  taste;  why  sugar  is  sweet,  and  succory 
bitter ;  why  my  hand  is  opened  or  shut  by  the  act  of  my  will  ?  And 
yet  you  dare  ask  the  therapeutist  why  quinia  cures  intermittent  fever, 
mercury  syphilis,  digitalis  idiopathic  palpitations  of  the  heart,  etc.  etc. 
Are  these  latter  phenomena  more  easy  to  explain  than  the  former  ? 
Is  it  not  just  the  reverse  '?  Is  it  not  plain  that  our  exactions  in  regard 
to  the  physician  are  unjust  and  unreasonable? 

We  distinguish  two  sorts  of  specifics :  the  one  which  acts  especially 
upon  certain  physiological  functions,  as  emetics,  diuretics,  emmena- 
gogues,  soporifics,  purgatives,  etc.,  were  known  to  the  ancients.  The 
other,  whose  specificity  is  manifest  only  in  certain  morbid  conditions, 
such  as  febrifuges,  anti-syphilitic,  anti-scrofulous  remedies,  etc.,  have 
been  appreciated  only  by  the  moderns. 

It  is  the  greatest  pride  of  modern  medicine,  and  without  contradic- 
tion its  best  title  to  the  gratitude  of  mankind,  that  it  has  discovered 
genuine  specifics  for  diseases ;  that  is  to  say,  remedies  as  sure  and  much 
less  painful  than  the  most  vaunted  surgical  proceedings.  A  physician 
who  vaccinates  a  child  in  order  to  protect  it  against  the  variolous  infec- 
tion, or  who  administers  a  salt  of  quinia  to  arrest  the  paroxysms  of 
intermitting  fever,  is  he  not  as  certain  to  obtain  a  decided  cure,  as  the 
surgeon  who  ties  an  artery  afi'ected  with  an  aneurismal  tumor,  or  who 
attempts  to  break  up  a  vesicular  calculus  by  the  ingenious  maneuver  of 
lithotrity  ?  Why  then  foolishly  call  the  conduct  of  the  first  empirical — 
which  in  our  language  means  blind — and  that  of  the  second  rational  ? 
Is  this  not  in  consequence  of  a  pure  mental  hallucination,  as  I  have 
elsewhere  peremptorily  demonstrated?  " 

As  to  myself,  firmly  convinced  that  the  synthetical  method,  which 
removes  diseases  almost  instantaneously  by  special  medications,  is  the 

"  See  Fourth  Letter,  §  3. 


670  APPENDIX. 

most  rational  as  well  as  the  most  efficacious  and  sure,  I  assign  to  it 
the  first  rank  among  therapeutical  methods.  I  do  not  hesitate  to 
proclaim  loudly,  that  it  accomplishes  better  than  any  other,  the  object  of 
our  Art,  and  shows  its  power  and  utility  more  manifestly  than  any 
other,  to  the  eyes  of  the  world. 


§11.      Anylitical    Method. 

Unfortunately,  it  is  not  always  possible  to  attack  a  malady,  that  is  to 
say,  a  collection  of  symptoms,  entirely  en  masse.  The  number  of  spe- 
cific medicines  is  still  extremely  limited.  In  the  must  common  cases, 
we  are,  therefore,  obliged  to  resort  to  analysis,  which  consists  in  decom- 
posing each  pathological  condition  into  a  certain  number  of  elements  or 
more  simple  maladies,  and  then  to  direct  against  each  one  of  these  mor- 
bid elements  an  appropriate  medication. 

I  suppose,  for  an  example,  that  we  have  to  treat  a  man  of  middle  age 
and  average  strength,  attacked  with  pneumonia.  Since  we  possess  no 
specific  against  this  affection,  the  following  is,  in  the  present  state  of 
the  science,  the  method  generally  pursued:  During  the  first  two  or 
three  days,  the  patient  will  be  bled,  in  order  to  diminish  the  san- 
guineous congestion  that  occurs  in  the  lung  ;  and  all  nourishment  is 
withheld  for  the  same  purpose.  Tepid  emolient  drinks,  which  diminish 
the  general  tension,  dispose  to  diaphoresis  and  moderate  the  internal  heat, 
by  which  the  patient  is  often  incommoded,  are  given.  Finally,  certain 
slightly  narcotic  drinks  are  administered,  in  order  to  calm  the  nerv- 
ous ij-"itation,  which  the  paroxysms  of  coughing  and  difficulty  of  respi- 
ration incessantly  provoke.  After  continuing  this  treatment  a  few 
days,  many  practitioners  give  tartar  emetic,  either  in  large  doses  (from 
six  to  ten  grains  to  five  ounces  of  water),  or  smaller  ones  (one  or  two 
grains  to  the  pint).  Experience  proves  that  the  use  of  this  medicine  in 
either  form,  is  followed  sometimes  by  alvine  dejections,  sometimes  by 
vomiting,  again  by  sweats,  or  also  by  two  or  all  three  of  these  phenom- 
ena. But  whatever  may  be  its  immediate  effects,  it  favors,  nearly 
always,  the  absorption  of  the  white  fluids  with  which  the  lung  is 
engorged  at  this  period  of  the  disease,  and  it  is  in  view  of  this  second- 
ary result  that  it  is  thus  given.  I  designedly  omit  to  mention  a  num- 
ber of  other  means  by  which  we  pi'opose  to  fulfill  different  indications. 
These  details  would  be  here  of  no  utility  Avhatever.  AYhat  precedes  suf- 
fices abundantly  to  explain  the  mechanism  of  the  analytical  method  at 
the  bed-side,  and  I  must  restrict  myself  to  that. 


SEVENTH    LETTER.  671 


COMPAR      SON     or     THE     TWO     PRECEDING     METHODS. 

It  is  sufficient  to  glance  at  the  description  of  each  of  these  therapeut- 
ical methods  in  order  to  be  convinced  that  the  first  is  the  most  simple 
and  the  most  natural,  and  that  its  application  requires  no  eifort  of  the 
mind ;  while  the  second,  more  complicated  and  more  artificial,  requires 
in  its  application  more  or  less  thought.  This  consists,  as  has  already 
been  said,  in  decomposing  a  pathological  state  into  its  several  elemen- 
tary lesions,  or  simple  aff"ections,  and  in  arranging  the  treatment  which 
shall  respond  as  much  as  possible  to  each  one  of  these  morbid  elements. 

It  is  true  that  by  this  mental  analysis  of  pathological  states,  our 
mind  seems  to  penetrate  farther  into  the  intimate  nature  of  the  disease, 
just  as,  in  the  combination  of  a  multiple  treatment,  it  appears  to  enter 
more  into  the  knowledge  of  the  physiological  action  of  each  modifier. 
In  a  word,  it  is  evident  that  the  analytic  method  requires  a  series  of 
intellectual  operations  and  reasonings,  more  or  less  abstract,  which 
the  synthetical  method  spares  us.  For  example,  far  less  labor  of  the 
intellect  is  necessary  in  order  to  prescribe  a  suitable  dose  of  quinia.  for 
an  individual  attack  with  intermittent  fever,  than  to  decompose  pneu- 
monia, typhoid  fever,  or  Asiatic  cholera  into  a  certain  nxxmber  of 
elements,  and  subsequently  to  direct  against  each  one  of  these  an  appro- 
priate medication.  It  is  therefore  not  astonishing  that  the  mind,  which 
often  judges  of  the  value  of  things  only  by  the  trouble  which  they  have 
cost  it,  in  comparing  the  extreme  simplicity  of  the  therapeutical  syn- 
thesis with  the  complications  of  anah^sis,  should  have  been  induced 
to  consider  the  first  process  much  less  wise  an  I  rational  than  the 
second.  " 

But  if,  laying  aside  this  gothic  prejudice,  we  estimate  things  as  we 
ought  to  do,  by  their  real  intrinsic  value — if  we  judge  the  therapeutical 
methods  by  their  degree  of  certainty  and  efficacy,  then,  without  doubt, 
we  shall  give  the  preference  to  the  synthetical  method ;  and  we  shall  be 
much  astonished  if  the  title  of  rational  should  be  denied  to  this,  in  order 
to  accord  it  exclusively  to  its  younger  sister,  to  whom  the  epithet  of 
arguer,  or  wrangler,  is  much  more  appropriate. 

*  There  was  also  a  time  when  the  merit  of  the  difficulties  overcome  was  held 
in  high  estimation  in  appreciation  of  literary  works.  At  that  epoch  flour- 
ished the  enigmas,  words  for  rhyming,  roundelays,  and  other  compositions, 
''jwsrlem  farinre.  The  law  giver  himself  of  the  French  Parnassus,  made  sacrifice  to 
this  bad  taste  when  he  said  : 

"  A  faultless  sonnet  is  better  than  a  long  poem." 


672  APPENDIX. 

That  which  contributes  still  to  perpetuate  the  common  illusion  in  favor 
of  the  Analytical  method  is  the  immense  service  which  it  has  rendered 
and  still  continues  to  render  to  chemistry ;  for  at  all  times  this  latter 
science  has  had  the  privilege  of  exercising  a  considerable  influence  upon 
medical  theories.  But  it  is  not  considered  that  chemical  differs  essen- 
tially from  therapeutical  analj^sis ;  the  first  operates  upon  palpable 
objects,  and  obtains,  by  decomposing  them,  fixed  and  determined  ele- 
ments. The  second  only  acts  upon  objects  purely  intellectual ;  it  decom- 
poses, not  diseases  themselves,  but  the  ideas  which  we  form  of  those 
diseases ;  it  does  and  can  only  obtain  variable,  uncertain,  and  imagin- 
ary elements.  Consider  well  this  capital  difference,  dear  reader,  and 
you  will  comprehend  why  the  Analytical  method,  which  leads  to  admi- 
rable discoveries  in  chemistry,  is  in  therapeutics  an  inexhaustible  source 
of  eiTors.  You  will  understand  why  the  clinical  analysis  of  Barthez 
differs  so  widely  from  that  of  Boerhaave,  and  why  that  of  Broussais 
does  not  resemble  either  of  the  other  two.  You  will  comprehend  why 
it  may  happen  that  of  two,  three,  or  ten  physicians  called  in  consulta- 
tion each  one  may  have  a  particular  notion  of  a  pathological  state, 
wliich  must  be  decomposed  mentally ;  while,  if  they  have  in  hand  a 
disease  for  which  the  Science  possesses  an  established  specific,  they  will 
be  nearly  unanimous. 

From  which  I  conclude  that  in  therapeutics,  synthesis  is  incomparably 
more  simple,  more  sure,  more  efficacious,  and  more  rational  than  analy- 
sis ;  that  the  highest  aim  of  this  branch  of  Medicine  consists  in 
restoring,  as  far  as  possible,  the  treatment  of  each  morbid  state  to  the 
synthetical  process ;  an  object  that  the  German  specific  sect  has  per- 
fectly understood,  in  proposing  as  an  object  of  research,  specific  remedies, 
without  troubling  themselves  whether  they  act  by  antipathy,  homeo- 
pathy, isopathy,  or  allopathy. 


III.     Expectant    Method. 

Synthesis  and  analysis  are  methods  common  to  all  the  sciences,  but 
tKerapeutics  embraces  others  which  are  peculiar  to  it ;  thus,  when  a 
disease  has  a  determined  and  rapid  course,  as  an  ephemeral  fever,  simple 
measles,  varioloid,  a  simple  wound  that  involves  no  important  part,  etc.; 
when  a  disease,  although  more  grave,  offers  no  alarming  symptoms,  and 
seems  to  tend  to  a  favorable  termination  by  the  simple  forces  of  nature, 
as  an  inflammatory  fever,  without  any  manifest  inflammation  of  an 
important  organ ;  when  a  disease  announces  itself  in  an  obscure  man- 
ner, and  there  is  nothing  urgent  in  the  case ;  finally,  in  a  multitude  of 


SEVENTH    LETTER.  673 

other  cases  wliicli  it  would  be  too  tedious  to  specify,  it  suffices  to  place 
the  patient  in  good  hygienic  conditions,  and  to  prevent  his  committing 
any  imprudence,  in  order  to  obtain  a  cure. 

In  such  cases,  nature  appears  to  supply  all  the  means  for  the  cure ; 
the  physician  has  only  to  look  on  and  hold  himself  in  readiness,  in 
order  to  correct,  when  necessary,  the  digressions  of  nature,  to  excite 
or  moderate  her,  to  sustain  her  forces,  to  aid  her,  in  a  word, 
according  to  the  indications  which  she  herself  furnishes.  The  part  of 
the  medical  man  in  these  cases  has  been  compared  to  that  of  a  servant 
or  agent  who  only  waits,  before  he  acts,  for  the  signal  of  the  master. 
Medicus  minister  naturce,  is  an  axiom  that  has  become  celebrated  in 
many  schools  of  Medicine,  but  which  is  absurd  when  it  is  made  appli- 
cable to  the  entire  system  of  therapeutics.-' 

Some  authors,  considering  the  office  of  the  physician  in  these  circum- 
stances as  nearly  a  nullity,  have  given  to  the  Expectant  method  the 
name  of  inactive  Medicine,  but  this  qualification  is  evidently  inexact, 
for  the  inaction  of  the  physician  is  only  apparent.  Although  he  may 
prescribe  nothing  energetic,  his  mind  does  not  cease  to  be  attentive  and 
occupied  ;  he  watches  over  the  progress  of  the  symptoms,  prevents 
imprudences,  regulates  the  regimen,  etc. ;  none  but  ignorant  persons  can 
regard  as  nidi  this  function  of  the  man  of  science.  Those,  on  the  con- 
trary, who  have  been  desirous  to  generalize  the  Expectant  method,  under 
the  title  of  Natural  or  Hippocratic,  consider  each  malady,  or  each  con- 
course of  particular  symptoms  as  a  regular  concatenation  of  phenomena, 
which  nature,  the  soul,  or  the  vital  principle  developes  with  the  deter- 
mined aim  of  curing.  Natura  Morhorum  Mediccdrix.  Xature  is  the 
sovereign  curative  agent  of  all  our  diseases — this  is  their  universal 
axiom  in  therapeutics.  But  if  it  is  true  that  nature  alone  cures  cer- 
tain aifections,  it  is  not  less  demonstrated  by  daily  observations  that 
she  is  often  impotent,  or  even  injurious,  without  the  intervention  of  Art. 
I  have  already  cited  very  striking  examples  of  this,  which  saves  here 
the  trouble  of  insisting  further  upon  this  point.'-' 

SECONDARY     METHODS. 

The  three  methods  which  1  have  just  described  embrace  all  therapeu- 
tical acts,  whether  internal  or  external.  There  is  not  a  single  medical 
prescription,  nor  a  single  surgical  operation  which  can  not  be  referred  to 
one  of  the  three  categories  of  medication  above  described.      However, 

*  If  on  many  occasions  a  physician  is  the  minister  naturce,  in  how  many  others 
is  he  also  mxigiHter  naturce. 
•'  See  Second  Letter,  §  4. 


674  APPENDIX. 

many  authors  have  given  the  name  of  therapeutical  methods  to  modes  of 
treatment  of  a  very  much  less  general  application.  Thus  they  have 
admitted  methods  called  anti-phlogistic,  derivative,  or  perturhative, 
substitutive,  etc.,  but  it  is  easy  to  see  that  each  one  of  those  enter  into 
one  or  the  other  of  the  three  preceding,  and  should  not  consequently  be 
arranged  on  the  same  line,  in  a  good  classification. 


§111.     Application    of    our    Theory    of    Curative   Methods. 

Let  us  suppose  that  it  is  desirable  to  appreciate  and  classify  the  treat- 
ments so  numerous  and  so  variously  advised  in  modern  times,  in  order 
to  combat  the  cholera,  a  question  replete  with  present  importance,  a 
truly  inextricable  chaos,  according  to  the  poor  doctrines  of  our  classics. 
God  forbid  that  we  should  wish  to  pass  in  review  all  the  means  that 
have  been  proposed  or  tried,  in  order  to  conjure  this  terrible  plague  I 
It  will  be  sufficient  to  direct  our  attention  to  a  few  of  them,  to  show 
how  we  may  seize  the  prevailing  idea,  and  assign  to  each  one  of  them 
the  rank  which  it  should  occupy  in  a  therapeutical  classification,  in 
order  that  every  attentive  reader  may  be  able  afterward  to  accomplish 
the  same  work  in  regard  to  any  treatment,  and  in  any  disease  whatever. 

FIRST    CATEOOUY  —  SYNTHETICAL     METHOD. 

There  are  physicians  who,  considering  all  the  cholera  phenomena 
as  the  manifestations  of  an  indivisible  morbid  entity,  have  endeav- 
ored to  arrest  its  development  by  the  aid  of  one  uniform  medi- 
cation, the  specific  efficacy  of  which  has  apj^eared  to  them  suf- 
ficiently justified  by  certain  observations,  or  certain  analogies  more  or 
less  well  founded.  Such  are  those  who  have  had  recourse  to  the  saline 
medication  in  the  use  of  chloride  of  sodium,  or  to  a  mercurial  treat- 
ment, or  to  the  nitrate  of  silver ;  those  still,  who  have  proposed  cin- 
chona and  the  salts  of  quinia,  under  the  title  of  prophylactics,  etc. 

SECOND     CATEGORY  —  ANALYTICAL     METHOD. 

Other  practitioners,  regarding  the  cholera  as  a  multiple  affection,  or 
at  least  polymorphous,  have  decomposed  it  by  mental  analysis  into  sev- 
eral elements,  or  simple  affections,  and  have  first  directed  their  thera- 
peutical resources  against  the  one  of  these  elements  which  seem  to  them 
to  govern  and  give  impulse  to  the  rest. 

We  arrange  in  this  category  the  treatment  by  diluent  drinks,  of  which 
the  obvient  object  is  to  dissolve  and  evacuate  the  acrid  matters  which 
are  supposed  to  engender  the  disease ;  that  by  evacuants,  emetics,  and 
purgatives,  employed  in  the  intention  to  expel  from  the  economy  the 


SEVENTH   LETTER.  675 

deleterious  principle  which,  corrupting  the  secreted  products,  provokes 
all  the  morbid  accidents ;  third,  the  treatment  by  anaesthetics  and  anti- 
spasmodics, such  as  opium,  ether,  chloroform,  etc.,  which  affect  particu- 
larly the  nervous  element ;  fourth,  the  anti-phlogistic  treatment,  the 
aim  of  which  is  to  combat  the  phlogosis  of  the  alimentary  canal,  which 
is  considered  as  the  prime  motor,  the  determining  cause  of  all  the  other 
phenomena ;  fifth,  the  use  of  stimulants,  such  as  aromatic  waters  more 
or  less  alcoholic,  tinctures,  ammonia,  galvanism,  etc.,  the  ordinary  effect 
of  which  is  to  arouse  the  oppressed  vital  forces,  to  arrest  the  alarming 
progress  of  prostration,  etc.,  etc. 

THIRD   CATEGORY  —  EXPECTANT   METHOD. 

None  of  our  practitioners  have  dared  essay  the  expectant  practice  in 
this  terrible  disease ;  for  the  office  of  the  temporizer  which  has  immor- 
talized the  name  of  Fabius  Cunctator,  is  more  difficult  to  sustain  in  the 
midst  of  the  general  alarm  and  trouble  menacing  all  the  functions  of 
the  organism,  than  to  head  an  army  impatient  to  measure  its  strength 
with  the  enemy.  The  value  of  this  method  cannot  therefore  be  judged, 
in  epidemic  cholera.  Xevertheless  there  arc  patients  who,  not  being 
able  to  obtain  the  counsels  of  a  medical  man,  or  being  unwilling  to  fol- 
low them,  like  the  lunatics  in  Salpetriere,  have  been  guided  by  instinct 
only.  May  it  not  be  said  that  in  this  class  of  sufferers,  in  which  there 
were  several  recoveries,  the  expectant  method  was  ilkistrated  ? 

Does  the  reader  see  with  what  facility  the  classification  of  such  numer- 
ous and  divergent  medications  announced  above,  is  effected  ?  Now  let 
him  attempt  to  perform  the  same  thing  by  means  of  therapeutical  clas- 
sifications in  common  use ;  he  cannot  accomplish  it  in  a  satisfactory 
manner.  He  could  never  decide  which  of  the  methods  of  treatment 
above  enumerated  merits,  to  the  exclusion  of  the  others,  the  title  of 
rational,  or  physiological,  or  natural,  or  empirical,  or  substitutive,  etc., 
for  these  epithets  are  nearly  equally  applicable  to  all ;  whence  it  follows 
that  they  characterize  none  in  a  special  manner. 


IV.     Classificatiox   and  Denomination   of   Medicaments. 

This  section  of  therapeutics  has  been  the  object  of  bitter  and  multi- 
plied recriminations.  There  is  not  a  single  treatise  on  Materia  Medica 
published  since  a  half  century,  in  which  the  instability,  confusion  and 
insufficiency  of  the  classifications  and  pharmaceutical  nomenclature  are 
not  deplored.  Bichat  has  pointed  out  to  us  the  principal  sources  of 
these  defects :  "  There  have  been  in  Materia  Medica  no  general  systems, 


676  APPENDIX. 

but  this  science  has  been  iufiuenced  by  turns,  by  those  who  have 
reigned  iu  Medicine ;  each  of  ■whose  opinions,  if  I  may  so  say,  has  been 
reflected  back  upon  it ;  hence  the  vagueness  and  the  uncertainty  that  it 
now  presents."  " 

Must  we,  to  avoid  these  causes  of  error,  adopt  the  classifications  of 
the  naturalists,  as  a  recent  author  in  Materia  Medica  and  therapeutics 
has  done  ?  f  I  think  not,  for  this  reason :  all  methodical  distributions 
of  the  materials  of  a  science  must  be  based  on  the  properties  which  this 
science  entertains.  Now,  what  properties  in  medicamental  agents  are 
considered  in  therapeutics  ?  Those  which  modify  the  animal  economy. 
It  is  necessary,  then,  to  name  and  class  these  pharmaceutical  materials 
according  to  the  modes  of  action  which  they  manifest  in  the  living 
organism.  To  seek  another  base,  less  Variable,  as  M.  Dieu  has  done,  is 
to  change  the  difficulty,  and  not  resolve  it. 

Unhappily  the  action  of  the  same  substance  on  the  animal  economy 
may  vary  according  to  numerous  circumstances,  which  it  is  often  diffi- 
cult to  appreciate  with  certainty.  For  example,  tartar  emetic,  admin- 
istered to  a  series  of  patients,  in  different  forms  and  doses,  can  produce 
a  sweat  in  one,  an  increase  of  bronchial  secretions  in  another,  alvine 
evacuations  in  a  third,  and  vomiting  in  a  fourth.  In  others  it  can 
arrest  vomiting,  stools,  etc.  Applied  to  the  skin,  this  substance  pro- 
vokes an  eruption  of  pustules,  followed  by  ulcers,  the  healing  of  which 
is  tedious.  Under  what  head  shall  we  rank  this  medicament?  Which 
of  its  effects  can  be  regarded  as  the  more  characteristic  and  essential  ? 
Answer :  the  one  which  is  the  most  sensible  and  the  most  constant. 

But  if  it  happens  that  a  remedy  produces  several  effects  nearly  equally 
remarkable,  to  which  shall  we  give  pi-cference  ?  It  is  not  important 
which  is  placed  in  the  first  rank,  provided  the  othei'S  are  carefully 
stated.  Thus,  I  would  not  hesitate  to  class  tartar  emetic  among  the 
emetics ;  but  I  should  not  complain  if  it  is  placed  among  the  irritants, 
provided  care  be  taken  to  note  its  property  as  a  vomit.  I  would  class 
opium,  in  like  manner,  among  the  anodynes  or  the  narcotics,  being  care- 
ful at  the  same  time  to  notice  that,  instead  of  calming  certain  pains, 
cephalalgia  for  example,  it  exasperates  them ;  that  instead  of  producing 
sleep,  it  sometimes  produces  agitation.  I  should  be  particularly  careful 
to  indicate  the  circumstances  that  influence  these  various  results. 

Finally,  it  may  happen  that  a  medicament  changes  its  position  in  the 
pharmaceutical  scale,  as  the  result  of  some  newly  discovered  property. 

**Anatomie  Generale.     Considerations  Generales,  §  II. 

t  M.  Dieu,  Pharmaceutist-JMnjor  and  Professor  in  the  Military  Hospital  of  Metz, 
lias  followed  fully  tlie  divisions  of  the  old  naturalists,  who  separated,  as  is 
shown,  all  substances  into  the  three  kingdoms. 


I 


SEVENTH   LETTEK.  G77 

Thus  ether  and  chloroform,  which  two  or  three  years  ago  were  classed 
exclusively  among  diffusible  stimulants,  may  now  very  properly  he 
ranked  among  the  anaesthetics. 

To  seek  in  any  order  of  knowledge  more  stability  and  more  perfection 
than  comports,  even,  with  the  nature  of  this  knowledge,  is  to  lose  time 
in  the  pursuit  of  a  chimera.  Now  the  Materia  Medica,  like  Chemistry, 
is  a  science  essentially  changeable.  The  merit  of  a  therapeutic  treatise 
does  not  consist  so  much  in  the  nomenclature  and  classification  of  cura- 
tive agents,  as  in  a  scrupulous  care  to  specify  well  the  circumstances 
which  cause  a  variation  in  the  effects  of  these  agents ;  not  in  attribu- 
ting to  them  any  imaginary  virtue  in  connection  with  this  or  that  medi- 
cal doctrine,  but  in  keeping  strictly  to  the  results  of  pure  observation. 


§V.     Conclusion. 

Up  to  this  time  no  one  has  embraced  in  the  same  plan  and  united 
under  one  principle,  internal  and  external  Medicine.  The  most  famous 
systematists  of  modern  times  have  always  been  careful  to  exclude  from 
their  therajjoutical  theories  surgical  operations;  that  is  to  say,  the 
medication  whose  effects  are  most  evident,  because  these  effects  do  not 
aid  them  in  their  theoretic  explanations.  Let  a  surgeon,  for  example, 
extirpate  a  tumor ;  no  one  could  say  that  he  had  acted  by  the  principle 
of  contraries  or  similars,  because  in  this  case  there  is  no  relation  of 
antagonism  or  similitude  between  his  operation  and  the  nature  of  the 
disease  which  he  treats.  But  it  can  be  well  said  that  he  attacks,  syn- 
thetically, the  product  of  the  morbid  affection. 

This  necessity  in  systems,  other  than  Empiri-methodism,  to  exclude 
from  the  therapeutic  scale  external  medication,  is  alone  sufficient  to 
prove  the  imperfection,  insufficiency  and  falseness  of  these  systems,  if 
already  I  had  not  demonstrated  this  falseness  in  various  ways  besides. 

It  is  true  that  Empiri-methodism  does  not  pretend,  like  most  other 
systems,  to  explain  the  intimate  connection  which  exists  between  the 
nature  of  diseases  and  the  mode  of  action  of  remedies.  We  willingly 
confess  our  ignorance  on  these  subjects,  which  are  impenetrable  to  the 
senses  as  well  as  the  mind.  We  avoid  carefully  hazarding  any  conjec- 
ture in  this  respect,  not  being  willing  to  offer  to  our  readers  arbitrary 
interpretations  for  truth,  and  ideal  fictions  for  material  realities. 


678  APPENDIX. 


EIGHTH  LETTER. 

KEPLY  TO  SOME  OBJECTIONS  CONCERNING  THE  EMPIEI-METHODIC  DOCTRINE. 
§1.     AReteospective  View. 

The  chief  aim  of  this  publication  being,  as  I  have  auuounccd  from  the 
commencement,  to  establish  the  practice  of  Medicine  on  an  immovable 
base,  to  protect  it  from  the  incessant  variations  of  phj'sio-pathological 
theories,  and  to  constitute,  in  a  scientific  manner,  the  Healing  Art, 
whose  processes,  often  disjointed  or  contradictory,  seem  to  have  among 
themselves  no  logical  union,  this  has,  it  appears  to  me,  been  sufficiently 
attained  in  the  preceding  letters. 

Indeed,  after  having  established  the  necessity  of  a  universal  axiom  in 
therapeutics,  of  a  certain  and  incontestable  evidence,  embracing  every 
possible  mode  of  curing,  whether  internal  or  external,  we  have  proved 
that  this  axiom  cannot  be  other  than  the  following :  that  medication 
which  has  cured  a  disease,  must  cure  equally  all  diseases  analogous  to  it. 
Whence  is  deduced  at  once  this  precept,  which  allows  of  no  exception : 
treat  each  case  by  means  lohose  ejfflcacy  has  been  demonstrated  by  expe- 
rience in  homogeneous  casesfi 

Afterward  we  have  shown,  that  the  rational  application  of  the  precept 
can  be  very  well  effected  by  means  of  three  general  methods  of  treatment, 
which  comprise  all  the  operations  of  Medicine  proper,  and  of  Surgery, 
without  any  alliance  with  physio  pathological  theories.f 

Thus  is  established  a  foundation  of  a  therapeutical  system  which  is 
both  rational  and  progressive:  thus  is  realized  the  agreement,  hereto- 
fore declared  impossible,  of  science  with  art,  of  theory  with  practice,  of 
reason  with  experience :  thus  is  constituted  what  may  be  called  the  great 
medical  strategy,  si  parva  magnis  componere  licet.  You  know  that  the 
part  of  a  physician  combatting  a  disease  has  often  been  compared  to 
that  of  a  general  in  presence  of  an  enemy.  Well,  if  I  may  be  allowed 
to  continue  the  similitude,  I  would  observe  that  sometimes  the  man  of 
war  attacks  his  foe  in  front,  and  attempts  to  overwhelm  and  destroy  him 
at  a  blow  ;  then  he  employs  the  synthetic  method.     At  another  time,  on 

''  See  Second  Letter.  f  See  Second  Letter 


EIGHTH   LETTER.  679 

the  contrary,  he  seeks  to  disunite  the  battalions  of  the  enemy,  in  order 
to  conquer  them  separately ;  in  this  case  his  method  of  attack  is  the 
analytical,  finally,  it  happens  sometimes  that  a  skillful  general 
avoids  committing  himself,  awaiting  a  favorable  occasion,  or  hoping  that 
his  adversary  will  become  exhausted  by  want  of  provisions  or  amuni- 
tion.     Has  not  this  tactic  much  resemblance  to  our  expectant  method  ? 

Thus  you  see,  that  according  to  the  system  of  rational  Empiricism,  or 
Empiri-methodism,  as  I  have  exhibited  it  in  these  letters  and  otherwise, 
the  practice  of  Medicine  is  scientifically  constituted,  without  any  suji- 
port  from  physio-pathological  theories ;  the  Art  of  curing  no  longer  offers 
the  strange  anomaly  of  processes  called  rational,  whose  efficacy  is  more 
than  doubtful,  by  the  side  of  others  called  ?io«-rational,  whose  efficacy  is 
perfectly  established ;  the  practitioner  is  no  longer  reduced  to  the  neces- 
sity of  making  the  humiliating  avowal,  that  he  can  never  cure  better 
than  when  he  treats  a  patient  without  knowing  why.  I  might  there- 
fore limit  here  my  task,  and  leave  to  others  the  care  of  developing  the 
principles  which  I  have  established ;  to  follow  their  application  through 
all  the  branches  of  medical  science,  and  to  show  how  these  principles 
govern,  in  all  their  details.  But  there  are  still  some  clouds  to  be 
removed,  some  objections  that  must  be  resolved,  concerning  the  ensemble 
of  the  empiri-methodic  doctrine,  and  in  answering  these  I  shall  termin- 
ate my  remarks  on  this  subject. 


§11.     First    Objectiox. 

We  read  in  the  Essay  on  Medical  Philosophy,  l)y  M.  Bouillaud:  "  We 
have  demonstrated  heretofore  that  diagnosis  is  the  essential  foundation 
of  therapeutics,  or  rather,  we  have  admitted,  with  all  physicians,  that 
this  is  an  axiom  that  needs  no  demonstration.  How,  indeed,  can  we 
treat  a  disease  which  we  do  not  know  ?  Therapeutics  is  really  only  a 
deduction  or  corollary  from  ideas  or  doctrines  which  we  form  on  the 
nature  of  diseases."" 

In  order  to  refute  victoriously  the  doctrine  emitted  in  this  passage 
by  the  celebrated  professor  of  La  Charite,  it  would  suffice,  doubtless,  to 
refer  the  reader  to  the  philosophic  axioms  which  I  gave  in  my  Fourth 
Letter,  and  to  the  corollary  which  accompanies  them.  But  I  will  not 
content  myself  with  an  indirect  refutation,  especially  because  there  is 
in  the  passage  which  I  have  just  cited  a  captious  sophism,  whose  artifice 
it  is  necessary  to  reveal.     "  How  treat,"  he  says,  "  a  disease  which  we 

'-  Essai  sur  la  Philosophie  Medicale,  part  ni,  cliap.  vi,  p.  302. 


680  APPENDIX. 

do  not  know  ?"  The  question  is  urgent,  and  T  do  not  know  tliat  M. 
Louis  or  M.  Cliormel,  to  whom  he  seems  to  address  himself  personally, 
has  ever  made  any  response  to  it.  I  shall  endeavor,  therefore,  to 
answer  it  in  their  place ;  hut  before  doing  so,  I  ask  to  be  permitted  to 
propose  a  question  myself. 

Is  not  a  gardener  obliged  to  know  the  plants  he  cultivates  ?  Must 
he  not  be  able  to  distinguish  a  cabbage  from  a  turnip,  a  carot  from  a 
beet?  Certainly  no  one  will  question  but  that  this  knowledge  is 
necessaiy.  Does  it  follow  from  this  that  he  can  deduce  by  reason  the 
rule  of  culture,  the  character  of  soil,  manure,  exposure,  etc.,  which  is 
appropriate  to  each  of  thescxvegetables  ?  Every  sensible  man  will  reply 
in  the  negative.  Take  any  man  you  please,  learned  in  botany  or  veg- 
etable physiology,  chemical  analysis,  or  microscopy;  suppose  that  he 
combines  the  knowledge  of  all  the  academies,  on  these  various  branches 
of  science,  yet  I  defy  his  capacity  to  deduce  from  them  directly,  the 
least  horticultui'al  rule,  without  some  previous  experience  of  his  own  or 
of  others.  Having  laid  down  this  proposition,  I  come  to  the  objection 
of  M.  Bouillaud. 

"  How  treat,"  you  say,  "  a  disease  which  we  do  not  know  ?"  Every- 
body will  agree  with  you  that  the  thing  is  impossible.  Every  one  will 
consent,  for  example,  that  to  treat  well  a  variola,  it  is  essential  not  to 
confound  it  with  a  syiihilitic  pustule,  and  that  to  treat  properly  an 
inguinal  hernia,  it  must  not  be  taken  for  a  bubo.  Thus  far  you  are 
right,  when  you  insist  on  the  importance  and  the  necessity  of  diagno- 
sis ;  when  you  affirm  that  without  an  enlighted  diagnosis  there  is  no 
rational,  effective  medication. 

But  because  therapeutics  can  not  proceed  safely,  if  it  is  not  guided 
by  the  light  of  diagnosis,  does  it  follow  that  it  needs  no  other  aid  ? 
Does  it  suffice  to  diagnosticate  well  a  disease,  in  order  to  know  how  to 
cure  it?  In  a  word,  is  therapeutics,  as  you  pretend,  a  deduction,  a 
corollary  from  our  ideas  on  the  nature  of  disease  ?  This  is  exaggera- 
tion and  an  error,  scarcely  conceivable  on  the  part  of  a  elinist  so  dis- 
tinguished as  the  professor  by  whom  it  has  been  emitted ;  an  error 
which  the  following  examples  will  make  perfectly  plain. 

Nearly  a  thousand  years  ago,  variola  was  known  to  Europe  ;  it  was 
described  by  the  Arabs  and  Arabists  with  such  exactness  as  to  leave 
little  for  their  successors  to  do.  Only  about  fifty  years  since  was  the 
discovery  made  for  the  prevention  of  this  disease  by  vaccination.  Do 
you  believe  that  this  discovery  is  a  deduction,  a  corollary  from  the  ideas 
which  were  then  held  on  the  nature  of  the  disease  ?  You  know  too 
much  of  the  history  of  the  propagation  of  vaccination  to  sustain  such 
a  heresy.     You  know  too  well  with  what  relentlessness  and  obstinacy 


EIGHTH   LETTER.  681 

this  operation  was  combatted  in  the  name  of  the  most  accredited 
theories. 

Intermittent  fevers  were  known  from  all  antiquity.  We  find  descrip- 
tions of  them  in  the  works  of  Hippocrates,  and  it  is  probable  that  the 
Asclepiadre  diagnosticated  these  diseases  nearly  as  surely  as  ourselves. 
Nevertheless,  we  cure  them  incomparably  better  than  they  did.  Do  we 
owe  the  perfection  of  our  therapeutics  in  this  respect  to  more  just  ideas 
on  the  nature  of  these  diseases  ?  You  well  know  the  contrary  ;  you 
know,  definitely,  that  the  introduction  of  the  great  febrifuge  took  place 
in  spite  of  the  reigning  ideas  and  theories  on  this  class  of  aifections. 

Finally,  what  disease  is  better  known  to  us  than  hydrophobia  ?  We 
know  its  origin,  how  it  is  communicated  to  man,  the  duration  of  its 
incubation,  its  course,  symptoms,  and  infallible  termination.  It  suffices 
to  have  seen  it  once  not  to  confound  it  with  any  aifection  of  another 
species.  Nevertheless,  its  therapeutics  is  no  more  advanced  than  it  was 
two  or  three  thousand  years  ago. 

And  you  dare  affirm  that  "  therapeutical  indications  are  evidently 
derived  from  the  diagnosis  of  the  disease ;  that  when  the  nature  of  the 
latter  is  exactly  known,  it  indicates  necessarily  the  remedy. "'•■■=  Never 
was  there  a  more  illusory  maxim  professed  in  Medicine.  Alas,  the  con- 
trary is  too  well  proved  by  the  history  of  our  Art.  No,  the  knowledge 
of  the  remedy  does  not  flow  from  the  knowledge  of  the  disease,  as  a 
conclusion  drawn  from  the  premises.  Diagnosis  constitutes  only  one  of 
the  premises  of  the  Art  of  curing ;  the  other  premise,  no  less  indispen- 
sable, is  clinical  proof.  Thus  the  Asclepiadge  understood  very  well 
intermittent  fevers  ;  but  before  clinical  proof  had  sanctioned  a  mode  of 
treatment,  the  Art  was  nearly  powerless,  science  was  lame,  relatively  to 
this  class  of  affections.  Thus,  our  diagnosis  of  hydrophobia  leaves  but 
little  to  desire,  while  our  therapeutics  is  still  and  will  always  remain 
miserable,  until  clinical  proof  shall  have  sanctioned  some  of  the  reme- 
dies employed  in  this  frightful  malady. 

According  to  the  opinion  of  M.  Buchez,  conformed  in  this  respect  to  the 
doctrine  of  all  modern  philosophers,  you  can  not  foresee  the  successive 
effects  engendered  by  the  introduction  of  a  therapeutic  agent  into  the 
animal  economy,  before  the  entire  succession  of  these  phenomena  have 
been  observed  once  at  least,  to  their  full  extent. f  So  much  more  im- 
possible is  it  that  the  diagnosis  of  a  disease,  however  exact  it  may  be, 
can  enable  us  to  foresee  the  series  of  modifications  which  any  given 
treatment  will  produce  upon  this  disease  before  the  entire  series  of 

"Essai  siirla  Philos.  Med.,  p.  321. 
•|-  See  Fourth  Letter. 

43 


682  APPENDIX. 

these  modifications  have  been  observed  at  least  once,  in  their  whole 
extent. 

Formerly  syphilitic  accidents  were  regarded  as  the  indices  of  a  virus, 
which  must,  by  all  means,  be  expelled  from  the  economy.  Consequently 
sweating  and  salivation  were  induced  and  continued  almost  to  exhaustion, 
in  the  individuals  attacked  with  some  of  these  symptoms  ;  after  all 
this,  they  were  purged.  Latterly,  some  pathologists  have  pretended  that 
the  venereal  symptoms  are  only  the  product  of  an  irritation  or  a  phlogosis  : 
consequently,  they  have  advised  the  application  of  antiphlogistic  medica- 
tion in  all  cases  of  this  nature.  The  Homeopaths  regard  these  same  acci- 
dents as  the  effects  of  an  impalpable  miasm,  and  feel  authorized  by  this 
hypothesis  to  oppose  them  with  spiritualized  remedies.  Both  have 
deduced,  apriori,  these  rules  of  treatment  from  their  respective  ideas  on 
the  nature  of  the  malady.  Both  have  followed  an  equally  false  route, 
based  on  hypothesis.  We  must  not  proceed  in  this  way  in  practical 
Medicine,  but  must  reason,  and  conduct  ourselves  as  follows : 

The  venereal  disease  is  manifested  by  symptoms  which  are  distin- 
guished now  into  primitive,  secondary  and  tertiary  or  constitutional. 
Experience  teaches  us  that  each  of  these  phases  requires  a  different 
medication.  Thus,  in  the  first  we  employ,  sometimes  with  advantage, 
astringents  or  diluant  drinks.  In  the  second,  the  salts  of  mercury  in 
small  doses,  aided  by  opiates  or  sudorifics,  generally  succeed  best,  without 
producing  salivation  or  any  other  sensible  evacuation.  Finally,  in  the 
third  period,  called  constitutional,  it  is  proved  that  the  salts  of  gold  and 
iodine  are  thus  far  the  most  efficacious  remedies.  Consequently  the 
philosophic  physician,  who  does  not  exaggerate  the  limits  of  our  intelli- 
gence— who  does  not  suffer  himself  to  be  imposed  upon  by  the  phantoms 
of  his  imagination,  will  employ  each  of  these  remedies  established  by 
experience,  at  the  appropriate  period  of  the  disease,  without  troubling 
himself  whether  the  disease  is  a  product  of  a  virus,  an  irritation,  or  a 
miasm,  all  of  which  are  impenetrable,  both  to  the  senses  and  to  the 
mind. 


§111.     Second    Objection. 

If  all  the  physio-pathological  theories  are  only  illusory  hypotheses, 
calculated  solely  to  mislead  the  physician,  they  should,  then,  be  ban- 
ished entirely  from  science,  as  dangerous,  or  at  least  useless  fictions. 
Nevertheless,  the  absolute  exclusion  of  theories  and  reasoning  appears 
to  be  impossible,  and  there  is  no  examjjle  of  it  in  any  medical  treatise  ; 
whence  it  follows  that  any  doctrine  which  rests  upon  such  exclusion, 


EIGHTH    LETTER.  683 

and  makes  a  formal  i^recept  of  it,  is  based  on  an  impossibility,  that  is 
to  say,  on  error. 

Such  is  the  objection  unceasingly  repeated,  under  a  thousand  forms, 
against  Empiricism;  and,  on  this  account,  this  system  is  not  studied 
thoroughly.'"'  It  is  accused  of  proscribing  reason,  because  it  desires  to 
suppress  its  abuse ;  of  rejecting  all  theories,  because  it  would  confine 
them  to  natural  limits.  It  is  time  to  make  account  of  this  prejudice, 
the  offspring  of  ignorance  and  thoughtlessness. 

EESPONBE. 

It  is  well  understood  that  when  I  use  the  word  Empiricism,  I  do  not 
allude  to  that  practiced  in  market-houses,  or  in  charlatan's  shops,  nor 
to  that  which  exhibits  a  great  display  of  curative  facts  in  advertise- 
ments. These  retailers  of  drugs  and  possessors  of  secret  remedies  and 
specific  treatments,  who  are  generally  denominated  Empirics,  know 
Empiricism  only  by  its  name.  But  when  duly  examined,  we  perceive 
at  once,  that  they  never  fail  to  entice  the  credulous  public  by  means 
of  some  physio-pathological  theory,  by  which  they  pretend  to  explain 
the  marvellous  effects  of  their  medication.  It  is  only  by  antiphrasis. 
therefore,  that  they  are  termed  Mnpirics  ;  because  in  reality  they  are 
in  theory  physio-pathologists,  in  their  way. 

It  is  now  well  understood  that  we  mean  rational  methodic  Empiri- 
cism, such  as  was  professed  by  some  of  philosophic  physicians  in  the 
ancient  school  of  Alexandria,  and  such,  especially,  as  I  have  heretofore 
developed.  Now,  I  ask  all  who  have  formed  the  least  notion  of  this 
doctrine:  is  reason  excluded  from  it?  Is  it  not,  on  the  contrary, 
founded  on  very  special,  if  not  very  true  reasoning  ?  What  have  I  been 
doing  in  the  whole  course  of  this  history,  except  laying  down  principles 
of  the  highest  philosophy,  and  deducing  consequences  therefrom  ?  Let 
our  adversaries  contest  these  principles,  or  the  consequences  we  have 
drawn  from  them ;  this  is  fair,  and  it  is  their  privilege.  But  that  they 
should  accuse  us  of  banishing  reason,  passes  all  imagination.  It  is 
equal  to  denying  the  light  of  the  sun,  and  shows  a  profound  ignorance 
of  the  history  of  medical  doctrines. 

The  reproach  that  it  annihilates  the  physio-pathological  theories,  if  not 
entirely  true,  has  at  least  some  claims  to  truth.  Yes,  Empiricism  does 
proscribe  the  intrusion  of  these  theories  into  thereapeutics ;  it  declares 
this  intrusion  to  be  injurious  and  illegitimate.  This  is  a  fundamental 
dogma,  which  I  have  demonstrated  in  my  Eourth  Letter,  in  such  a  man- 
ner as  to  leave  no  doubt  in  the  minds  of  attentive  readers.     But  rational 

*  Broussais,  in  hia  Examination  of  Medical  Doctrines,  devotes  to  this  system 
tnly  a  paragraph  of  a  few  lines.     See  chap,  ii.,  p.  35,  edition  1821. 


684  APPENDIX. 

Empiricism,  or  Empiri-metliodism,  does  not  exclude  in  any  fashion, 
physiological  and  pathological  theories  from  their  natural  domain,  that 
is  to  say,  from  physiology  and  pathology.  I  am  far  from  sharing  the 
opinion  of  Laennec,  who  regards  these  creations  of  genius  as  vain  amuse- 
ments of  the  mind.  I  consider  them  for  my  part,  as  eminently  useful 
inventions,  and  as  indispensable  auxiliaries  to  the  human  understand- 
ing. These  physio-pathological  theories  have  not  been  injurious  to 
Medicine,  except  in  the  abuse  that  has  been  made  of  them  by  the  dog- 
matists, in  transporting  them  from  their  legitimate  domain  into  that  of 
therapeutics.  Some  examples  will  enlighten  us  on  the  use  of  theories 
in  the  sciences,  and  on  the  danger  of  their  excessive  extension. 

FIKST    EXAMPLE. 

An  apple  becomes  detatched  spontaneously  from  its  branch  and  falls 
to  the  ground.  A  pendulum,  withdrawn  from  the  vertical  line,  oscillates 
for  some  time.  The  planets  describe  around  the  Sun  an  ellipsis  of  which 
that  body  is  the  center.  Here  are  facts  which  seem  to  have  among 
themselves  no  connection,  which  thus  isolated,  leave  in  the  memory  but 
a  slight  trace.  But  a  man  of  genius  conceived  the  happy  idea  of  con- 
necting these  phenomena  to  an  unique  cause:  he  supposed  that  the  apple 
is  drawn  toward  the  earth  by  an  invisible  force  which  he  called  attrac- 
tion ;  that  the  pendulum  oscillates  from  the  same  cause,  and  that  the 
planets  are  retained  in  their  orbits  by  a  similar  force.  Observations, 
experiments,  and  calculations  without  number,  were  undertaken  to  verify 
this  hypothesis ;  all  seem  to  confirm  it,  all  lend  themselves  to  this  inter- 
pretation. From  that  time,  a  multitude  of  phenomena  which  had  been 
before  unnoticed,  because  they  had  among  themselves  no  apparent  con- 
nection, attracted  the  attention  of  the  learned,  became  fixed  in  their 
memories  by  means  of  this  artificial  bond,  and  constitute  one  of  the 
most  beautiful  conquests  of  science. 

But  if,  quitting  the  domain  of  general  physics,  we  wish  to  carry  the 
theory  of  attraction  into  chemistry,  if  we  pretend  to  explain  by  it  ele- 
mentary affinities,  we  fall  into  chaos,  we  abuse  the  hypothesis.  Indeed 
the  theory  of  Newton  supposes  no  difi"erence  in  the  particles  of  matter, 
while  chemical  affinities  are  based  precisely  upon  these  difierences. 

SECONIi     EXAMPLE. 

The  hypothesis  of  an  interior  agent  called  vital  principle,  or  better,  vital 
force,  which,  being  endowed  with  an  admirable  instinct,  but  not  with  con- 
sciousness, giving  impulsion  to  all  the  movements  of  the  organized  body 
and  directing  them  to  a  common  end,  according  to  a  wonderfully  combined 
plan ;  this  hypothesis,  emitted  by  Hippocrates,  exaggerated  by  Von  Hel- 
mont,  brought  back  to  its  true  terms,  and  elevated  almost  to  the  degree 


EIGHTH   LETTER.  685 

of  demonstrated  truth  by  the  moderns,  is  unquestionably  one  of  the 
most  beautiful  creations  of  physiological  science ;  without  it,  a  great 
number  of  the  phenomena  of  the  living  economy  would  remain  incom- 
prehensible and  without  common  bond  of  union. 

But  when  an  effort  is  made  to  introduce  this  theory  into  therapeutics, 
we  arrive,  if  we  wish  to  be  logical,  to  the  negation  of  the  Healing  Art: 
the  position  of  the  j^hysician  is  reduced  to  a  simple  contemplation  of 
death,  as  Asclepiades  reproached  the  Hippocratists  of  his  time.  If  on 
the  contrary  it  is  sometimes  desirable  for  the  physician  to  interfere 
actively  in  disease,  he  is  forced,  like  Stahl,  Bavthez  and  others,  to  con- 
tradict himself  continual ly.'--' 

THIRD     EXAMPLE. 

Pinel  ranked  intermittent  fevers  of  the  tertian  type,  in  the  order 
of  bilious  fevers,  which  he  also  denominated  meningo-gastric ;  those 
of  the  quotidian  or  quartan,  in  the  order  of  pituitous  or  adeno- 
meningeals ;  finally,  the  pernicious  intermittents  and  remittents  were 
classed  by  him  in  the  order  of  ataxise.  Hemorrhage,  neuroses,  and 
other  periodical  affections  were  disseminated  in  divers  sections.  Brous- 
sais  attached  all  these  morbid  forms  to  phlogosis  and  especially  to 
gastritis. 

Nevertheles,  both  did  not  hesitate  to  combat  all  these  affections  with  the 
salts  of  quinia,  contrary  to  their  pathological  theories,  but  in  order  not  to 
renounce  these,  they  qualified  this  beneficial  medication  as  irrational. 
Ah,  pardon  me,  illustrious  masters,  it  is  not  the  medication  that  is 
irrational  under  these  circumstances,  it  is  yourselves  who  are  so  illogi- 
cal in  pretending  to  unite  the  disease  to  the  remedy  by  the  bond  of 
induction,  while  they  can  be  united  only  by  observation  and  experience. 


rOUKTH     EXAMPLE. 


Inflammation,  in  Latin,  inflammatio,  in  Greek,  (pAe'fiiaaca,  or 
(pXayoac:,  is  a  subject  which  has  excited  as  much  discussion  among 
physicians  as  the  real  presence,  or  sufficient  grace,  has  excited  among 
theologians,  with  this  difference,  however,  that  the  disputes  of  the 
children  of  Esculapius  have  not  kindled  the  flames  of  the  stake,  nor 
excited  persecution.  Apart  from  that,  they  have  not  been  less  keen, 
nor  less  obstinate ;  and  still,  so  far  from  being  extinguished,  certain 
authors  deny  the  existence  of  phlogosis,  while  others  extend  this  mode 
of  lesion  to  all  pathology.  Truth,  according  to  us,  is  not  in  any  of 
these  extreme  opinions. 

*  See  Second  Letter,  §  2,  also  the  theory  of  Barthez,  in  the  body  of  the  work. 


686  APPENDIX. 

In  fact,  if  we  go  back  to  the  origin  of  science,  we  see  that  the  words 
phlegmasia,  phlogosis,  and  inflammation  have  been  employed  on  account 
of  the  similitude  which  has  been  thought  to  exist  between  the  effects  of 
this  disease  and  those  of  caloric.  Now,  here  is  what  has  been  remarked 
in  regard  to  the  latter :  if  any  part  of  our  body  is  exposed  at  a  moderate 
distance  to  a  fire,  we  feel  at  first  an  agreeable  warmth.  Soon  this  sen- 
sation grows  painful,  and  the  part  begins  to  redden.  Next  we  feel 
a  keen  sensation  of  burning,  the  color  becomes  of  a  deeper  red,  and 
tumefaction  begins.  Later,  the  skin  becomes  covered  with  phlyctaenae  or 
bullse,  filled  with  serosity — tha  cellular  subcutaneous  tissue  now  feels 
the  action  of  the  caloric.  Finally,  mortification  attacks  the  superficial 
layers  of  the  tissues,  and  advances  deeper  and  deeper,  until  it  attacks 
the  deep-seated  layers.  But  if  the  action  of  caloric  ceases  before  it 
causes  the  mortification,  then  the  affected  part  recovers  its  normal 
state,  with  or  without  suppuration,  with  or  without  any  loss  of  sub- 
stance, according  to  the  severity  of  the  burn. 

Such  is  an  abridged  account,  omitting  many  shades  in  the  succession 
of  phenomena  produced  by  the  action  of  external  caloric  on  any  part 
whatever  of  the  body.  Now,  as  the  same  phenomenal  series  may  be 
provoked  in  the  organism  by  other  causes,  either  internal  or  external, 
the  name  of  inflammation  was  primitively  given  to  the  assemblage  of 
three  or  four  of  the  following  symptoms :  heat,  redness,  pain,  swelling. 

Numerous  theories  have  been  emitted  on  the  initial  phenomenon,  and 
the  mode  of  generation  of  the  phenomenal  series  called  inflammatory  ; 
and  the  authors  or  the  partisans  of  these  theories  have  all  had  the  pre- 
tention to  base  on  each  one  of  them  an  anti-phlogistic  treatment,  which  is 
the  cause  of  the  many  variations  in  this  treatment. 

Finally,  in  our  times,  numerous  researches  and  experiments  have  been 
undertaken,  with  a  patience  and  minuteness  above  all  eulogy,  in  order 
to  seize  the  intimate  molecular  transformations  which  the  tissues  and 
living  liquids  undergo  in  their  passage  from  a  normal  to  a  phlogosed  state. 
Aided  by  the  microscope,  physio-chemical  analysis,  dissections,  etc.,  a 
sort  of  scale  of  phenomenal  gradation  has  been  established  from  simple 
irritation  to  confirmed  phlegmasia.  The  caliber  of  the  capillary  vessels 
has  been  seen  to  contract  at  first  under  the  influence  of  chemical  or 
physical  irritants,  and  dilate  again ;  the  movements  of  the  liquids  in 
the  same  vessels,  after  a  momentary  accelleration,  move  slower,  then  stop 
entirely.  The  serum  of  the  blood  transudes  the  parieties  of  the  vessels, 
carrying  with  it  the  coloring  matter  in  a  state  of  solution,  and  the 
globules  themselves  have  been  seen  to  be  deformed.  The  generation  of 
the  pus  has  been  observed  from  its  very  beginning. 

But  when  we  wish  to  pass  from  this  pathogeny  to  therapeutics,  it  is 


EIGHTH    LETTER.  687 

plain  that  no  rational  tie,  perceptible  to  our  understanding,  unites  the 
facts  which  make  up  these  two  departments  of  Medicine,  We  are  con- 
vinced that  the  most  exact  and  profound  knowledge  of  the  series  of 
pathological  phenomena  can  not  furnish  directly  the  indication  of  the 
most  suitable  and  efficacious  remedies,  nor  can  it,  in  a  word,  take  the 
place  of  therapeutical  proof.  The  following  is  an  avowal  which  the 
most  skillful  observers  do  not  hesitate  to  make  when  they  are  not 
blinded  by  some  preconceived  theory :  "  We  can  not  yet,  unhappily,'" 
says  M,  Lebert,  "  construct  therapeutics  on  the  basis  of  scientific  Medi- 
cine, and  with  the  best  intentions  in  the  world,  we  can  regard  the 
greater  part  of  its  precepts  but  as  the  result  of  Empiricism.  "=^' 

I  would  observe,  in  connection  with  this  passage,  that  henceforth  the- 
rapeutics is  established  scientifically,  not  on  pathological  physiology, 
according  to  the  desire  of  M.  Hebert,  but  on  another  base,  more  sure 
and  larger,  the  only  one  on  which  all  its  precepts  can  rest,  namely : 
experience  or  rational  Empiricism,  otherwise  called  Empiri-methodism. 
There  is  not  a  single  rule  of  therapeutics  that  can  be  justified  otherwise 
than  by  the  results  of  experiment.  The  precept  of  reuniting  divided 
parts  has  been  cited  as  an  example  of  rational  therapeutics,  Xow  this 
precept  is  neither  more  nor  less  rational  than  that  which  directs  the 
use  of  cinchona  in  intermittent  fever.  Why  has  it  been  advised  to 
unite  divided  parts  ?  Because  it  is  known  by  observation,  that  in  cer- 
tain cases  the  divided  parts  are  susceptible  of  reunion.  But  there  arc 
also  cases,  unhappily  but  too  numerous,  which  observation  also  has 
made  known  to  us,  in  which  the  divided  parts  can  not  again  be  united. 
Would  in  this  case,  the  precept  to  bring  them  together,  be  rationaV'. 
N"o,  certainly  not,  for  experience  has  proven  otherwise. 


IV.     Third    Objection. 

"Empiricism,"  says  Broussais,  "consists  in  finding  a  remedy  appropriate 
to  the  disease,  without  taking  the  trouble  to  explain  the  latter,  nor  the 
manner  in  which  it  is  modified.         "  "        Anorexia  is  cured 

sometimes  with  water,  sometimes  with  wine,  sometimes  by  purging,  at 
others  by  fasting,  and  again  by  eating  food  more  freely,  or  of  a  more 
exciting  character  than  ordinary,  etc.  What  do  then  ?  If  we  do  not 
wish  to  reason  or  form  a  theory  in  order  to  discover  which  of  the  means 
should  be  employed,  it  only  remains  to  try  first  one  then  the  other,  "f 

'=  Physiol.  Pathol.,  vol.  I,  p.  103.    Paris,  1846. 
f  De  I'Irritation  et  de  la  Folie,  p.  b'o. 


688  APPENDIX. 

I  would  not  have  quoted  this  objection,  so  trifling  does  it  appear,  if 
it  had  not  emanated  from  a  man  who  has  exercised  an  incontestable 
influence  on  cotemporaneous  Medicine;  the  name  of  Broussais  im- 
poses upon  me  the  obligation  not  to  pass  it  silently.  Nevertheless,  I 
shall  be  short  in  my  refutation,  not  being  willing  to  avail  myself  of  all 
the  advantages  which  the  feebleness  of  the  attack  afibrds  me. 

RESPONSE. 

You  say  that  a  want  of  appetite  is  cured  sometimes  with  water,  some- 
times with  wine,  etc.  I  ask  how  you  have  learned  that  this  afi'ection. 
or  if  you  like  it  better,  this  symptom,  may  be  treated  by  means  so 
diverse,  and  often  so  opposite  ?  Is  it  not  by  observation,  and  observation 
alone  ?  AVhat  physio-pathological  theoi-y  could  have  suggested  such  a 
great  variety  of  treatments,  applicable  to  a  disease  always  the  same 
in  appearance  ?  None  ;  it  is  clinical  observation  only  which  has 
furnished  us  with  this  notion. 

You  add,  if  we  do  not  wish  to  reason  or  form  a  theory,  in  order  to 
discover  which  of  these  means  should  be  adopted,  it  only  remains  to  try 
them  successively.  I  pass  the  common  accusation  of  want  of  reasoning. 
with  which  the  partisans  of  Empiricism  are  charged — an  accusation 
unworthy  of  Broussais,  who  knew,  definitely,  that  the  Empirics  do  not 
neglect  reasoning — an  accusation  which  has  already  been  sufiiciently 
refuted,  and  I  come  to  his  conclusion,  that  we  are  compelled  to  try  all 
methods  of  treatment  successively,  if  we  have  no  physio-pathological 
theory  to  guide  us,  and  reply : 

Yes,  certainly,  we  are  obliged  to  attempt  successively  all  medications, 
if  after  the  example  of  certain  reformers  we  take  no  account  of  the 
observations  of  our  predecessors — if  it  be  pretended  to  form  science 
anew,  from  its  base  to  its  top  stone  ;  but  such  has  never  been  the 
pretension  of  the  Empiri-methodists,  and  the  first  physicians  who 
assumed  the  title  of  Empirics  in  the  school  of  Alexandria,  have  left 
us  very  wise  rules  by  which  to  discern  the  degree  of  confidence  which 
should  be  accorded  to  the  observations  of  others — which  proves  that 
they  did  not  disdain  to  make  use  of  them. 

Thus,  then,  from  whatever  point  of  view  we  study  therapeutics,  in 
generalities  or  in  details,  always  and  everywhere,  induction  must  be 
subordinate  to  experience  ;  the  rules  of  treatment  must  have  received 
the  sanction  of  clinical  proof,  before  obtaining  citizenship  in  the 
science. 


NINTH   LETTER.  689 


NINTH  LETTER. 

ON  THE  EANE  THAT  MEDICINE  SHOULD  OCCUPY  IN  A  GENEEAL  SYSTEM  OF 
HUMAN  KNOWLEDGE,  AND  THE  DEGREE  OF  CERTAINTY  WHICH  IT  CAN 
ATTAIN. 

§  I.  Propriety  of  this  Inquiry. 

After  having  assigned  to  each  of  the  branches  of  Medicine  its 
proper  place,  having  had  regard  to  the  importance  of  its  influence  for 
the  realization  of  the  final  aim  of  this  science — the  curing  of  maladies  ; 
after  having  demonstrated,  contrary  to  the  opinion  of  a  great  number 
of  theorists,  that,  in  this  respect,  therapeutics  holds  the  first  rank,  and 
that  pathology,  anatomy,  physiology,  etc.,  follow  as  auxiliaries ;  after 
having,  in  short,  brought  forth  medical  practice  from  the  chaos  into 
which  it  was  plunged,  by  re-establishing  the  true  theory  of  the  Healing 
Art,  misunderstood  and  misrepresented  for  twenty  centuries,  I  think  it 
will  not  be  improper  to  examine  what  place  Medicine  should  occupy  in 
a  systematic  classification  'Of  all  the  sciences,  and  what  degree  of  cer- 
tainty it  is  susceptible  of  attaining.  This  research  constitutes,  it  seems 
to  me,  the  supreme  complement  of  all  medical  doctrine  and  should  close 
properly  this  epistolary  series. 

Nevertheless,  I  am  not  ignorant  how  little  the  present  epoch  is 
favorable  to  philosophic  dissertations ;  that  in  the  midst  of  a  society 
disturbed  like  ours,  and  menaced  in  its  foundations,  physicians  can 
only  lend  a  distracted  ear  to  questions  of  pure  theory,  the  examination 
of  which  requires  calmness,  security,  and  leisure.  Moreover,  I  will  not 
abuse  the  patience  of  my  readers  ;  I  shall  attempt  to  say  only  what  is 
absolutely  indispensable  for  the  solution  of  the  problems  announced  at 
the  head  of  this  letter.  In  this  manner  I  pretend  to  recognize  the 
kind  reception  which  has  been  given  to  my  philosophic  lucubrations,  and 
to  testify  my  gratitute  in  particular  to  the  honorable  confrere  who 
directs  with  so  much  impartiality  and  discernment  the  publication  of 
this  estimable  journal.'- 

Being  obliged  to  glance  at  the  diverse  opinions  of  philosophy,  concern- 
ing the  origin  of  our  acquirements,  their  degree  of  certainty,  and  the 

*  L'Union  Medicale. 


690  APPENDIX. 

various  modes  of  acquisition  of  our  understanding,  I  shall  divide  my 
subject  into  two  parts — one  historical,  the  other  critical  and  dogmatical. 


Part  First. — A  Historical  Resume  of  the  Opinions  which  have  been  emitted  on  the 
Origin  of  Ideas,  and  their  Modes  of  Development. 

§   II.     Antique    Period. 

RATIO KALISM. 

The  first  philosopher  whose  writings  have  come  down  to  us  in  a  suffi- 
cient state  of  entirety  to  give  a  just  idea  of  his  doctrine  is  Plato,  the 
elegant  disciple  of  the  sage  Socrates,  who  from  the  charms  of  his  con- 
versation and  the  gracefulness  of  his  style,  was  surnamed  the  Swan  of  the 
Academy.  He  thought  that  the  knowledge  which  we  acquire  in  this 
world  is  only  the  feeble  rays  of  the  light  that  our  soul  possessed  before 
its  union  with  the  body,  and  he  was  persuaded  that  the  best  means  to 
find  truth  consists  in  isolating  ourselves  as  much  as  possible  by  medita- 
tion, from  the  influence  of  the  senses  and  exterior  objects,  in  order  to  put 
ourselves  in  direct  communication  with  the  intimate  nature  of  things 
by  mental  intuition.  "  The  soul,"  he  says,  "  never  thinks  better  than 
when  it  is  undisturbed  by  sight,  pain,  or  voluptuousness,  and  when,  shut 
up  within  itself,  disdaining  as  much  as  possible  all  commerce  with  the 
body,  it  grasps  directly  what  it  desires  to  know.  '■'     =-■■=  Indeed, 

the  body  involves  us  in  a  thousand  embarrassments,  owing  to  the  neces- 
sity of  our  cares  for  it.  Added  to  this,  diseases  which  spring  up  obstruct 
our  researches.  They  fill  us  with  passions,  desires,  fears,  a  thousand 
chimeras  and  follies,  to  such  an  extent  that  in  fact  they  leave  us,  as  has 
been  said,  not  one  hour  for  wisdom.  =••'=  "  *  ''  It  is  thus  demon- 
strated that  in  order  to  know  a  thing  thoroughly  we  must,  so  to  say. 
separate  ourselves  from  the  body,  that  the  soul  may  examine  them  in 
themselves.'"' " 

ON     SENSITISM. 

Aristotle,  cotemporary  with  Plato,  was  one  of  his  most  assiduous 
auditors  during  twenty  years ;  after  which  he  became  the  chief  of  a 
school.  Now,  he  professed  an  opinion  entirely  contrary  to  that  of  his 
master,  on  the  origin  of  our  ideas.  According  to  him,  all  animals  have 
received  from  nature  the  faculty  of  feeling  and  judging;  but  after  the 
sensation  has  been  produced  some  preserve  the  remembrance  of  it,  while 
others  do  not.     Those  whose  souls  retain  some  trace  of  the  received 

**  Phedon.    French  translation,  of  Cousin,  p.  202-204. 


NINTH    LETTER.  691 

impressions,  can  in  the  course  of  a  great  number  of  sensations,  reason 
Trom  the  recollection  of  them  which  remains.  This  explains  how  the 
memory  arises  from  the  faculty  of  feeling.  The  memory  of  the  same 
thing  often  repeated,  produces  experience  ;  and  experience,  that  is  to  say, 
every  general  notion  which  is  fixed  in  the  soul,  relatively  to  what  is 
common  to  several  things,  is  the  principle  of  Science  and  Art.  The  first 
ideas  which  the  sensations  create  in  our  minds  are  always  ideas  of 
totality,  or  very  general  ideas.  Subsequently,  in  proportion  as  the  same 
sensations  are  reiterated,  they  become  more  distinct,  and  more  and 
more  special." 

Aristotle  insists  very  much  on  this  proposition,  that  the  first  ideas 
which  arise  in  our  minds  by  the  intervention  of  the  senses,  are  always 
very  general  ideas.  They  form  a  fundamental  basis  for  his  scientific 
method ;  and  he  supports  this  by  examjDles  and  reasoning  which  he  thinks 
invulnerable.  If  a  man,  he  says  in  one  place,  perceives  an  object  at  a 
distance,  he  will  have  at  first  the  idea  of  a  body  in  general.  If  the 
object  gradually  approaches  him,  and  he  sees  it  advance  with  an  autom- 
atical motion,  his  general  idea  of  a  body  will  change  to  the  less  general 
one  of  an  animal ;  subsequently,  to  that  of  an  animal  of  some  particular 
species ;  then  finally,  the  object  coming  very  close,  he  will  distinguish  it 
from  all  others,  he  will  in  short,  obtain  an  individual  idea.  Elsewhere 
he  cites  the  example  of  a  little  child,  who  calls,  at  first,  every  man  papa, 
and  every  woman  mama ;  afterward,  as  he  grows  older,  his  ideas  become 
special,  he  learns  to  discern  his  father  and  his  mother  from  all  other 
persons. 

Such  is,  according  to  this  philosopher,  the  gradation  of  our  ideas,  and 
on  this  basis  he  establishes  a  scientific  method,  which  all  antiquity 
adopted ;  a  method  which  consists  in  commencing  the  study  and  the 
teaching  of  any  science  whatever  by  generalities,  which  are  also  called 
principles,  or  elements. 

It  must  be  borne  in  mind,  that  the  argumentations  of  the  chief  of 
the  Peripatetics,  and  the  examples  with  which  he  sustains  them,  are 
extremely  captious.  It  would  be  very  difficult  for  us  to-day  to  show 
its  artifice,  if  Locke  and  Condillac  had  not  demonstrated,  absolutely, 
that  the  first  ideas  excited  in  us  by  the  sensations  are  always  individual 
in  their  character :  if  they  had  not  taught  us  by  their  learned  analyses 
of  the  operations  of  the  understanding,  how  our  mind  rises  from  indi- 
vidual to  general  ideas,  and  in  what  respect  these  differ  from  vague  and 
indistinct  ideas,  with  which  Aristotle  confounds  them  in  the  examples 

*  Aristotelis  Opera  Omnia  quae  extant  Grasce  et  Latine.  Autlaore  Guillemo 
Duval.  Analyticorum  Posteriorum,  lib.  II.,  cap.  xrx.  De  Principibus  Naturali- 
bus,  lib.  I.,  cap.  i.     Metaphysicorum,  lib.  I.,  cap.  i.;  et  alibi  passim. 


692  APPENDIX. 

above  given.  But  the  ancients,  deprivad  of  the  lights  of  modern 
metaphysics,  could  not  shake  oiF  the  yoke  of  the  Peripatetic  method, 
whose  prestige  was  maintained  down  to  an  epoch  very  near  our  own. 

In  Peripateticism,  the  sensations,  though  forming  the  point  of  depart- 
ure of  our  acquirements,  are  not  considered  as  our  only  instruments  in 
intellectual  progress ;  they  constitute  only  the  materials  of  thought,  and 
reason  maintains  there  her  supremacy  over  the  other  faculties  of  the 
soul.  She  has  the  task  of  elaborating  and  setting  in  order  the  materials 
for  the  construction  of  the  scientific  edifice. 

It  is  not  entirely  the  same  in  the  system  of  Epicurus,  if  we  may 
credit  his  elegant  Latin  interpreter.  According  to  him,  the  sensations 
are  all  produced  by  images  or  shadows,  extremely  delicate,  which,  detached 
from  the  surfaces  of  bodies,  or  spontaneously  formed,  float  in  space,  and 
impress  our  senses.  The  senses  never  mislead  us ;  truth  has  no  surer 
foundation  than  their  authority,  and  our  existence  depends  on  the  exact- 
ness of  their  impressions.  When  we  form  false  judgments,  it  is  reason 
alone  which  is  misled  in  its  operations."  Here,  as  is  plain,  the  theory 
of  Sensitism  is  pushed  to  its  extreme  limits,  and  forms  the  most  com- 
plete antagonism  with  the  doctrine  of  Plato. 

ON     KCLECTICISM. 

Potamo,  who  lived  at  Alexandria  about  the  first  century  of  the  Chris- 
tian era,  that  is  to  say,  at  an  epoch  when  philosophic  disputes  were  very 
animated,  having  recognised,  or  supposed  that  he  recognised,  that  none 
of  the  systems  proclaimed  with  so  much  warmth  by  the  contending  sects 
were  entirely  true,  though  each  contained  a  portion  of  truth  mingled  with 
many  errors,  thought  that  wisdom  consisted  in  not  attaching  himself 
exclusively  to  any  of  the  prevailing  doctrines,  but  to  extract  from  each 
one  what  he  judged  most  conformable  to  experience  and  reason.  History 
does  not  say  whether  he  reduced  this  manner  of  philosophizing  to  a 
system,  nor  that  he  gained  disciples.  However  this  may  be,  he  was 
considered  as  the  founder  of  Eclecticism,  or  Syncretism,  a  method  which 
had  among  the  ancients  many  partizaus,  but  whose  sectators  never 
formed  a  school,  properly  said,  because  they  never  adopted  a  precise 
formula,  or  common  symbol  of  doctrine. 

SKEPTICISM. 

I  shall  not  pause  to  examine  Skepticism,  because  absolute  and  uni- 
versal doubt  appears  to  me  less  a  scientific  doctrine  than  the  negation  of 
any  species  of  knowledge.  The  reasoning  of  the  Pyrrhoneans  does  not 
merit,  in  my  opinion,  any  serious  refutation ;  because  it  oflFers,  according 

^  Lucretius,  Poeme  de  Natura  Rerum,  chant  IV. 


NINTH   LETTEK.  693 

to  the  avowal  of  its  own  philosophers,  no  character  of  certainty.     I  will 
content  myself,  then,  with  repeating  with  Lucretius, 

Denique,  nil  sciri  si  quis  putat,  id  quoque  nescit 
An  sciri  possit;  qiioniam  nil  scire  fatetur. 


§111.   Middle    Period. 

SUPERNATUEALISM. 

To  the  two  modes  of  intellectual  acquisition  admitted  by  philosophers, 
the  fathers  of  the  Christian  Church  have  added  a  third,  which  they  con- 
sidered as  the  surest  and  the  only  infallible  one.  This  mode  which  is 
called  revelation  or  supernaturalism,  consists  in  the  direct  communica- 
tion which  God  has  made  to  man,  of  certain  truths,  which  could  not 
have  been  discovered  by  the  mere  lights  of  reason.  Nevertheless, 
philosophy  does  not  abdicate  entirely  its  rights  to  examine  these  lofty 
truths  ;  for  while  their  celestial  origin  is  proclaimed,  they  present  several 
points  which  were  evidently  the  offspring  of  human  reason;  thus  it 
might  be,  and  has  been  asked  indeed,  by  what  signs  are  we  to  recog- 
nise that  aDy  revelation  is  really  divine  ;  how  can  we  assure  ourselves 
that  a  given  proposition  comes  from  a  supernatural  source,  etc.  Xow, 
it  is  evident  that  all  these  questions  are  within  the  competency  of  phi- 
losophy. Thus  many  ancient  fathers  of  the  Church  studied  the  Greek 
philosophers,  and  endeavored  to  conciliate,  at  least  in  part,  the  doctrines 
of  these  philosophers  with  the  dogmas  of  religion.  Of  this  number 
were  Justin  the  Martyr,  Saint  Clement  of  Alexandria,  Saint  Origen, 
and  Saint  Augustine.  Others,  however,  such  as  Quintillian,  Arnobus, 
and  Lactantius,  did  not  consent  to  this  plan,  and  regarded  the  study 
of  philosophy  as  superfluous  and  dangerous. 

ox     SCHOLASTICS. 

In  the  ages  of  barbarism  and  ignorance  which  followed  the  establish- 
ment of  the  Christian  religion,  in  the  midst  of  the  long  perturbations 
kept  up  by  the  dismembering  of  the  Grseco-Eoman  Empire,  and  the 
establishment  of  new  states,  the  taste  for  letters  and  philosophy  sensibly 
declined ;  the  writings  of  the  philosophers,  buried  under  the  dust  of 
libraries,  remained  there  unknown  even  to  their  owners ;  and  when 
Charlemagne  instituted  those  numerous  schools  which  became  after- 
ward universities,  the  only  remains  of  ancient  philosophy  which  had 
not  been  entirely  forgotten  were  the  metaphysics  and  logic  of  iVristotle. 
During  that  indefinite  lapse  of  centuries,  which  is  called  the  Middle 
Ages,  the  ecclesiastics,  who  were  the  sole  depositories  of  the  treasures 


694  APPENDIX. 

of  human  knowledge,  employed  at  first  Peripatetic  dialectics,  in  their 
essays  on  moral  truths  and  the  dogmas  of  religion.  Subsequently  they 
supposed  they  could  reach  by  the  same  way,  that  is  to  say,  by  pure  dis- 
cussion and  reason,  the  discovery  of  natural  laws  and  the  solution  of  all 
the  problems  of  the  physical  sciences. 

They  usually  proceeded  as  follows :  they  laid  down  some  axioms  or 
universal  principles  of  metaphysics,  whence  they  drew  by  a  series  of 
arguments,  the  explanation  of  all  the  phenomena  of  nature.  This 
method  of  philosophizing  was  called  scholastic,  from  the  name  of  the 
schools  where  it  originated  and  where  it  was  employed  until  very 
recently. 

It  ref|uired  many  years,  many  eiforts,  and  many  contests,  before  the 
human  mind  could  disengage  itself  from  the  shackles  of  this  vicious 
method,  which  was  still  so  much  credited  at  the  close  of  the  sixteenth 
century,  that  Eamus,  or  La  Eamee,  professor  in  the  University  of  Paris, 
exposed  himself  to  the  rudest  persecutions  for  having  dared  criticise  it. 


§IV.    Third   Period. 


REVIVAL     OF     PHILOSOPHY. 


I  will  not  attempt  to  retrace  even  succintly,  the  admirable  concourse 
of  circumstances  which  prepared  the  freedom  of  thought ;  the  discoveries 
in  the  sciences  and  arts,  the  restoration  of  the  literary  monuments  of 
antiquity  by  the  art  of  printing,  the  uprising  of  public  opinion  against 
the  abuse  of  the  power  of  the  clergy  and  the  feudal  nobles,  etc.; 
all  this  would  require,  even  to  be  sketched  only,  much  more  space 
than  I  have  at  my  disposal.  I  come  then,  without  preamble,  to  the 
revival  of  philosophy,  which  includes  in  it  the  whole  progress  of  the 
human  mind. 

In  the  first  half  of  the  seventeenth  century,  two  men  of  a  character 
and  genius  quite  different,  started  from  opposite  points,  the  one  from 
sensation,  the  other  from  mental  intuition,  to  rebuild  the  entire  edifice 
of  science.  They  agreed,  however,  in  this,  that  each  one  should  reject 
equually  the  lumber  of  the  scholastic  method,  and  create  his  own 
method.  The  first,  replete  in  the  knowledge  of  statesmanship,  having 
filled  the  highest  places  in  the  state,  substituted  induction  for  syllogism 
as  the  habitual  form  of  reasoning,  and  proclaimed  the  sovereignty  of 
experience  as  the  scientific  criterion  and  the  true  means  of  discoveries. 
The  second,  on  the  contrary,  withdrawing  from  the  world  and  its  honors. 
a  friend  of  solitude  and  meditation,  a  mind  eminently  generalizing, 
who,  though  still  young,  had  acquired  great  renown  by  his  discoveries  in 


NINTH   LETTER.  ,  695 

mathematics,    replaced   all   the  complicated  rules   of    the   Peripatetic 
dialectics  by  a  single  one,  admitting  as  characteristic  of  truth,  evidence 
alone.     The  reader  has  already  anticipated  the  names  of  Francis  Bacon 
i        and  Bene  Descartes,  the  two  restorers  of  the  philosophy  of  modern  times. 

ON     SENSITI3M. 

Bacon,  like  Aristotle,  placed  the  source  of  our  knowledge  in  the 
faculty  of  feeling  ;  but  he  maintained  contrarily  to  the  latter,  that  the 
sensitive  impressions  give  rise  at  first  to  particular  ideas,  and  not  to 
general  ones.  Thus,  though  adopting  the  scientific  basis  of  the  philo- 
sopher of  Stagyrus,  he  separates  at  once  from  him,  to  follow  another 
route,  entirely  different.  The  chief  of  the  Peripatetics  wished  to  begin 
science  by  the  most  general  and  abstract  notions,  named  therefore  by  him 
principles  or  elements.  The  English  philosopher  protested  on  the  con- 
trary, with  all  his  might,  against  this  course;  he  assumed  that  our  minds 
can  never  suddenly  rise  at  a  single  bound  from  individual  ideas,  excited 
by  the  senses,  to  axioms  or  general  principles.  He  insists  that  progress 
should  be  gradual,  and  not  by  leaps ;  that  we  should  pass  from  a  par- 
ticular idea  to  one  that  is  somewhat  general ;  from  this  to  another,  more 
general,  and  so  on,  till  we  reach  the  universal  axioms,  which  should  be, 
he  says,  the  last  ones  laid  down.  Bacon  insists  obstinately  on  this 
method ;  he  recommends  it  constantly ;  he  renews  its  exposition  in 
various  ways,  in  various  terms,  in  several  portions  of  his  books,  for  fear 
that  it  might  not  be  sufficiently  comprehended  or  appreciated  ;  he  exalts 
its  value  much  above  all  particular  discoveries. 

Posterity  has  confirmed  the  judgment  of  Bacon  on  the  excellency  of 
his  method,  which  has  been  adopted  and  improved  by  learned  men  and 
thinkers  of  the  first  order,  and  which  has  contributed  much  to  the  pro- 
gress of  the  human  understanding,  especially  in  the  physical  sciences. 

John  Locke  enlarged  and  cleared  the  route,  which  Bacon  has  merely 
indicated  by  land  marks.  He  showed  by  what  series  of  acts  the  mind 
rises  from  a  sensation,  which  furnishes  it  a  simjjle  or  individual  idea,  to 
complex  or  compound  ideas ;  how  we  form,  by  abstraction,  general 
ideas,  ideas  of  species,  genera,  or  classes.  He  made  excellent  observa- 
tions on  the  nature,  formation,  and  errors  of  language,  refuted  the  Pla- 
tonic doctrine  of  innate  ideas,  and  admitted  with  Aristotle  and  Bacon, 
sensitive  impressions  as  the  only  basis  of  our  knowledge.  He  endeav- 
ored to  demonstrate  empirically,  that  is  to  say  by  the  testimony  of  the 
senses,  the  existence  of  God,  His  attributes,  the  immortality  of  the 
soul,  in  a  word,  all  the  truths  of  natural  religion  and  morals. 

Stephen  Bonnot  de  Condillac  was,  in  France,  the  extreme  representa- 
tive of  Sensitism  ;  he  supposed  that  all  the  faculties  of  the  soul,  and  all 


696  APPENDIX. 

its  determinations  are  derived  from  the  faculty  of  feeling.  According 
to  this  metaphysician,  attention  is  nothing  more  than  a  prolonged  sen- 
sation, which  effaces  all  others  for  the  moment ;  that  comparison  and 
judgment  consist  in  two  sensations,  which  are  realized  simultaneously, 
or  are  united  in  the  memory  as  if  they  were  really  simultaneous ; 
and  so  on  for  the  other  intellectual  faculties.  The  acts  of  the  will  he 
represented  as  proceeding  from  the  same  origin.  Thus  the  sensations, 
which,  considered  as  representations  of  objects,  are  the  source  of  ideas, 
become  the  source  of  all  the  acts  of  the  will,  accordingly  as  they  effect 
us  agreeably  or  disagreeably.  Hence  arise,  following  this  theory,  our 
diseases,  our  habitudes,  our  vices  and  our  virtues. 

No  one  in  France  has  contributed  as  much  as  Condillac  to  popularize 
the  taste  for  philosophic  studies,  by  his  clearness  and  connection  of 
ideas.  But  does  he  not  turn  these  studies  from  their  true  object  in 
making  the  supreme  perfection  of  the  sciences  to  consist  in  the  mere 
perfection  of  the  signs  of  language  ?  Is  it  not  evident  that  he  mistakes 
the  effect  for  the  cause,  when  he  attributes  the  exactness  of  reasoning  in 
mathematics  to  the  exactness  of  algebraic  language  ?  This  grave  mis- 
take has  not  a  little  contributed  to  perpetuate  in  the  schools,  and  among 
the  learned  societies,  those  vain  disputes  on  words,  which  he  had  him- 
self so  much  blamed. 

Condillac,  like  Locke,  endeavors  to  derive  moral  and  religions  ideas 
from  sensation  ;  but  other  philosophers  deduced  from  these,  no  less  suc- 
cessfully, the  destruction  of  these  same  ideas.  Thomas  Hobbs,  David 
Hume,  Charles  Bonnet,  Claude  Adrian  Ilelvetius,  and  others,  have 
proved  victoriously,  that  the  theory  of  sensations  is  not  unfavorable  to 
skepticism,  materialism,  and  atheism. 

ox      RATIONALISM. 

Descartes  perceived,  early,  that  the  instruction  he  had  received  in  the 
schools  or  drawn  from  books,  under  the  name  of  philosophy,  was  nothing 
more  than  a  scaffolding  of  words,  or  an  art  of  speaking  without  judgment, 
as  he  said,  on  things  of  which  we  are  ignorant.  His  mind,  habituated 
to  the  exact  researches  of  mathematics,  could  not  be  contented  with  a 
science  so  visionary ;  consequently  he  resolved  to  reconstruct  it  from 
top  to  bottom.  To  this  end,  he  commenced  by  erasing  everything  which 
he  had  learned,  excepting  from  his  philosophic  doubt,  but  the  practical 
truths  whose  application,  he  said,  could  not  be  dispensed  with. 

Then  he  laid  down,  as  the  basis  of  his  scientific  edifice,  this  fact, 
incontestable  to  every  reflective  mind:  "  I  think  ;"  that  is  to  say,  I 
have  conscience  of  my  thought ;  from  which  he  drew  at  once  this  con- 
clusion, no  less  incontestable:     -'therefore  1  exist.''     This  is  as  much 


NINTH  LETTER.  697 

as  to  say :  there  is  in  me  a  thinking  substance,  which  I  call  soul ;  a 
substance  essentially  distinct  from  matter ;  a  substance,  in  fine,  the 
reality  of  which  is  clearer  and  more  evident  to  my  mind  than  that  of  my 
body,  and  all  exterior  objects.  This  soul,  whose  essence  consists  in 
thought,  finds  in  itself  the  innate  idea  of  a  being  or  a  spirit,  absolute, 
unlimited  in  its  attributes — on  the  infallibility  of  which,  the  certainty  of 
all  our  knowledge  rests. 

As  long  as  this  philosopher  did  not  go  beyond  the  sphere  of  pschycho- 
logical  phenomena,  his  propositions  are  linked,  naturally  ;  but  when  he 
endeavors  to  pass  into  the  domain  of  natural  phenomena,  it  seems  as  if  the 
route  was  closed  to  him — he  is  obliged  to  have  recourse  to  hypotheses 
which  are  entirely  arbitrary.  Thus  he  supposes,  in  physics,  that  matter 
is  not  endowed  with  any  activity,  which  is  contrary  to  all  observations. 
In  physiology,  after  saying  that  the  soul  is  present  in  all  parts  of  the 
body,  he  assigns  to  it,  for  a  special  seat,  the  pineal  gland ;  he  puts  at 
its  disposal  a  host  of  animal  spirits — a  species  of  intelligent  messengers 
— who  go  and  come  from  one  extremity  of  its  organic  empire  to  the 
other,  either  to  carry  its  orders  or  to  bring  back  intelligence  of  what  is 
going  on.="' 

Xotwithstanding  his  errors,  Descartes  influenced  in  a  powerful  man- 
ner the  progress  of  the  human  understanding ;  he  gave,  as  was  said,  the 
death-blow  to  the  scholastics.  The  clearness  of  his  conceptions,  the 
boldness  of  his  hypotheses,  excited  the  mind  to  think  for  itself,  and  cast 
off  the  prejudices  of  a  scholastic  education.  A  great  number  of  learned 
men  studied  his  doctrine,  either  to  develop  and  defend  it,  as  Nicole, 
Pascal,  Spinosa,  Malebranche,  or  to  combat  it,  as  Gasscndi,  Hobbes,  and 
others. 

Godfried  Wilhelm  Leibnitz,  one  of  the  most  universal  geniuses  of 
modem  times,  attempted  to  put  an  end  to  the  disputes  of  the  yarious 
philosophic  schools,  by  uniting  all  their  doctrines  into  one,  which  should 
retain  what  was  true  in  all,  and  reject  what  was  false  or  hypothetical. 
He  proceeded  to  the  execution  of  his  vast  project  by  the  speculative 
method  of  Descartes,  whose  philosophy  he  called  the  antechamber  of 
truth,  while  he  had  little  regard  for  the  empirical  method  of  Locke. 
Like  the  French  philosopher,  he  placed  in  God  the  foundation  of  all  reality, 
all  knowledge,  and  all  certainty.  He  admits  innate  ideas,  not  as  present 
to  consciousness  from  birth,  but  as  allied  to  our  intellectual  constitution 
by  a  necessary  relationship.  He  accords  to  matter  only  the  force  of 
inertia,  or  resistance,  and  to  explain  the  active  forces  with  which  bodies 
appear  endowed,  he  supposes  that  each  of  them  is  only  the  natural 

___^ £ 

'  (Euvres  de  Philosophique. 

44 


698  APPENDIX. 

evolution  of  a  monad,  or  a  simple,  indivisible,  imperishable,  and,  in 
some  sort,  spiritual  molecule,  which  is  the  motor  of  all  the  spontaneous 
developments  of  tangible  bodies — the  source  of  all  active  properties, 
and  which  reflects  in  miniature  the  entire  universe. 

The  philosophy  of  Leibnitz,  though  more  comprehensive  than  that  of 
Descartes,  is  not  less  hypothetical,  as  is  seen,  nor  less  distant  from  the 
results  of  daily  observation. 

Emanuel  Kant,  before  engaging  in  the  researches  of  ontology,  endeav- 
ored to  determine  the  laws  and  the  limits  of  our  faculty  to  acquire,  in 
order  to  avoid  the  principal  cause  of  error  of  human  reason,  whiuh  cause 
resides  in  the  almost  irresistible  inclination  which  we  have  to  pass,  con- 
tinually, the  limits  within  which  the  Author  of  nature  has  confined  our 
understanding.  Consequently  he  applied  himself  with  rare  sagacity 
and  perseverence  to  discern  knowledge  rational,  or  a  priori,  and  knowl- 
edge empirical,  or  a  posteriori.  Here  is  a  resume  of  his  doctrine  on 
this  subject: 

Observation  teaches  us  with  certainty  that  a  thing  exists  in  such  or 
such  a  manner ;  but  it  does  not  teach  us  that  it  could  not  possibly  exist 
otherwise.  Its  judgments  are  never  strictly  universal ;  they  possess  but 
a  conditional  generality  ;  which  means  that  no  one  has  remarked  to  the 
present,  an  exception  to  a  given  law  of  nature,  as,  for  example,  to  the 
following:  all  bodies  have  weight.  On  the  contrary,  a  judgment 
applied  with  rigorous  universality,  that  is  to  say,  in  a  manner  which  , 
admits  of  no  exception,  cannot  come  from  experience,  but  is  absolutely 
a  priori.  Such  are  the  following  propositions:  Two  quantities  equal  to 
a  third,  are  equal  to  each  other.  Nothing  happens  without  a  cause. 
Thus  necessity  and  universality  are  the  characteristics  of  all  rational 
or  a  priori  knowledge.  Contingency  and  limitation  form  the  essential 
character  of  all  empirical  or  a  posteriori  knowledge. 

Fichte  and  Schelling,  who  have  followed  Kant  in  the  speculative 
route,  appear  to  have  had  as  a  principal  aim,  to  found  ontology  on  an 
immutable  basis  by  demonstrating  the  objective  reality  of  the  concep- 
tions of  the  understanding.  Have  they  succeeded  in  this  great  enter- 
prize  ?  This  is  a  question  which  I  shall  not  undertake  to  examine  here, 
for  it  is  much  more  pertinent  to  metaphysics  and  morals  than  to  the 
physical  sciences,  of  which  Medicine  forms  a  part.  Besides,  the  response 
to  such  a  question  surpasses  very  much  my  abilities :  Non  iiostrum 
iantam  componere  litem. 

ON   COMMON    SENSE    AND   SENTIMENT,    CONSIDERED   AS   A    MEANS   OP   KNOWtEDOE. 

Neither  the  exclusive  Sensitists,  nor  the  pure  Eationalists  having 
been    able  to  construct  an  entire  system  of  knowledge  which  would 


NINTH    LETTER,  699 

satisfy  equally  observation  and  reason,  some  philosophers  flattered  them- 
selves to  have  found  in  common  sense,  or  universal  sentiment,  a  surer 
guide,  an  infallible  criterion  of  truth.  The  Irishman  Hutcheson,  was 
one  of  the  first  who  emitted  this  opinion,  but  it  owes  its  principal  lus- 
ter and  the  notice  of  the  learned  world,  to  the  labors  of  several  Scotch 
philosophers,  at  the  head  of  whom  it  has  been  usual  to  place  Thomas 
Eeid,  which  has  given  to  the  doctrine  itself  the  name  of  Scotch  School. 
These  learned  men,  seeing  that  the  most  common  truths  in  morals  and 
experience  were  shaken  by  the  speculations  of  certain  philosophers,  and 
desiring  to  establish  them  on  an  unapproachable  base,  supposed  man  to 
be  endowed  with  a  moral  sense,  a  sort  of  spiritual  instinct,  which  leads 
him  naturally  to  truth  and  to  correct  action,  which  inspires  him  only 
with  sound  judgments,  when  he  does  not  choke  this  interior  voice  by 
prejudices  and  bad  passions.  According  to  this  theory,  the  common  sense 
of  humanity,  that  is  to  say,  instinct,  considered  in  its  most  general  and 
most  irresistible  manifestations,  is  a  certain  principle  of  knowledge,  an 
infallible  criterion  of  truth.  Among  the  writers  who  in  other  countries 
have  contributed  to  popularize  this  doctrine,  we  must  name  J.  J.  Rous- 
seau, in  France,  and  Henry  Jacobi,  in  Germany. 

ECLECTICISM. 

There  have  always  been  Eclectics,  that  is  to  say,  learned  men  who, 
instead  of  endeavoring  to  distinguish  themselves  by  the  inventio"  of 
some  new  system,  have  been  content  to  extract  from  each  of  the  cotem- 
poraneous  systems  as  much  truth  as  in  their  eyes  was  contained  in  them, 
and  to  stitch  together  these  various  pieces,  in  order  to  form  a  body  of 
doctrine  which  would  represent  as  exactly  as  possible  the  sum  of  the 
acquisitions  of  the  human  understanding  at  a  given  epoch.  In  this 
way  Fernel,  at  the  commencement  of  the  sixteenth  century,  united  with 
much  skill  the  theory  of  Plato  to  that  of  Aristotle ;  thus  also,  in  our 
days,  a  professor  in  the  Univei-s-ity  of  Paris ^has  offered  to  his  auditors 
the  resume  of  modern  philosophic  opinions  in  a  highly  critical  work,  of 
which  the  following  is  the  substance,  as  condensed  by  himself: 

"  The  eighteenth  century,"  he  says,  "  has  left  us  a  heritage  of  three 
grand  schools,  which  remain  to  this  time :  the  French  and  English 
school,  of  which  Locke  is  the  chief,  and  of  which  Condillac  is  among  us 
the  most  accredited  representative ;  the  Scotch  school,  which  presents  so 
many  illustrious  names,  Hutcheson,  Smith,  Reid,  and  Dugald  Stewart ; 
the  German  school,  or  rather  the  school  of  Kant,  for  of  all  the  philoso- 
phers beyond  the  Rhine,  he  of  Kcenigsberg  is  about  the  only  one  who 
appertains  to  history. 


700  APPENDIX. 

"  But  this  is  only  an  ethnographical  enumeration  of  the  schools  of  the 
eighteenth  century.  It  is  especially  necessary  to  consider  them  in  their 
analogous  or  opposite  characters.  The  Anglo-French  school  represents 
particularly  Empiricism  or  Sensualism  ;  that  is  to  say,  an  almost  exclu- 
sive importance  is  attributed  in  all  departments  of  human  knowledge  to 
experience  in  general,  and  especially  the  experience  of  the  senses.  The 
Scotch  school  and  the  German  school  represent  a  spiritualism  more  or 
less  developed.  Finally,  there  are  philosophers  who,  denying  the 
supremacy  of  the  senses  and  reason,  seek  in  the  sentiment  the  true 
guide  and  light  of  intellectual  and  moral  life ;  for  example,  Eousseau, 
in  France,  Smith  and  Hutcheson,  in  Scotland,  and  Jacobi,  in  Germany. 
Such  are  the  philosophic  schools  which  prevailed  in  the  eighteenth 
century. 

"  Is  the  truth  to  be  found  in  either  of  these  schools  exclusively  ? 
We  are  compelled  to  say  that  neither  of  them  contains,  in  our  eyes, 
truth  in  full.  We  are  convinced  that  a  considerable  part  of  knowledge 
escapes  the  sensations,  and  we  believe  sentiment  is  not  a  basis  firm 
enough  or  large  enough  to  sustain  human  science.  We  are  then  rather 
the  adversaries  than  the  partisans  of  the  school  of  Locke  and  Condillac, 
and  of  that  of  Hutcheson  and  Jacobi. 

"  In  general,  in  the  history  of  philosophy,  we  are  in  favor  of  all 
those  systems  which  favor  reason ;  thus,  for  antiquity,  we  hold  to  Plato 
rather  than  to  Aristotle  ;  among  moderns,  we  are  for  Descartes  against 
Locke  ;  and  in  the  eighteenth  century,  for  Eeid  against  Hume,  for  Kant 
against  Condillac  and  Jacobi.  But  at  the  same  time,  while  we  recog- 
nize reason  as  a  force  superior  to  sensation  and  sentiment,  as  being  par 
excellence  the  faculty  of  knowing,  the  faculty  of  truth,  and  beauty,  and 
all  good,  we  are  persuaded  that  reason  can  not  develop  itself  under 
conditions  which  are  foreign  to  it,  nor  suffice  for  the  government  of  man, 
without  another  power ;  this  power,  which  is  not  reason  itself,  and  which 
it  can  not  reject,  is  sentiment ;  the  conditions  without  which  reason  can 
not  develop  itself,  are  the  senses.  We  now  see  how  important  to  us  are 
sensations  and  sentiment ;  how,  consequently,  it  is  impossible  for  us  to 
condemn,  absolutely,  either  the  philosophy  of  sensation  or  that  of 
sentiment.  "=■•' 

I  pray  the  reader  to  excuse  me  for  the  extent  of  this  quotation.  Never- 
theless, I  am  persuaded,  that  after  having  read  it,  he  will  thank  me  for 
not  having  abridged  it ;  for  it  offers,  as  briefly  as  possible,  an  expose, 
nearly  complete,  of  the  philosophic  doctrine  called  Eclecticism. 

*  Cousin : — Cours  de  I'Histoire  de  la  Philosopliie  Moderne,  vol.  ir,  p.  366,  ed. 
1836. 


NINTH  LETTER.  701 


Pakt  Second. — A    Critical  and  Dogmatical  Examinadoyi  of  the  various  Systems  of 
Philosophy  abovementioned. 

§  V. 

The  fragment  whicli  I  have  just  reported,  simplifies  and  will  abridge 
singularly  the  second  part  of  this  letter.  The  appreciation  which  is 
found  there,  of  modern  systems  of  philosophy,  appears  to  me  perfectly 
just,  and  I  would  give  to  it  my  full  assent,  if  the  author  had  better 
explained  the  nature  and  special  destination  of  each  of  these  faculties  of 
the  understanding  which  he  presents  as  a  principle  of  knowledge, 
namely:  common  sense,  or  the  sentiment,  sensation,  and  pure  reason. 

OS     INSTINC  T — T  HE     PEINCIPLE    OF     SENTIMENT     AND     COMMON    SENSE. 

When  we  reflect  on  the  manifestations  of  this  faculty  which  the  phi- 
losophers of  the  Scotch  school  name  common  sense,  and  which  others 
name  sentiment,  we  find  that  it  has  no  other  source  than  instinct,  that  is 
to  say,  that  innate  light,  that  natural  aptitude  for  certain  acts,  which 
develops  itself  spontaneously  among  animals  as  well  as  among  men,  from 
the  first  moment  of  their  birth,  or  at  determined  periods  of  their  exist- 
ence.  Instinct  suffices  for  the  common  needs  of  life ;  it  is  the  principle 
of  the  most  natural  sentiments,  it  guides  us  before  experience  and  reason 
are  yet  formed,  it  furnishes  us  sometimes  the  promptest  inspirations, 
surer  even  than  the  teachings  of  experience  and  reason.  It  is  not  sus- 
ceptible either  of  memory  or  education,  according  to  physiologists,  and 
should  not  be  consequently  ranked  among  the  number  of  the  philosophic 
faculties,  that  is  to  say,  those  which  are  perfectible. 

"A  complete  opposition,"  says  M.  Flourons,  the  interpreter  of  Frederic 
Cuvier,  "  separates  instinct  from  intelligence.  In  instinct  all  is  blind, 
necessary  and  invariable :  in  intelligence  all  is  elective,  conditional  and 
modifiable.  The  beaver  who  builds  his  cabin,  the  bird  who  constructs 
her  nest,  act  only  from  instinct.  The  dog  and  the  horse,  who  learn  even 
the  signification  of  many  of  our  words,  and  who  obey  us,  do  so  by  intel- 
ligence. All  in  instinct  is  innate :  the  beaver  builds  without  having 
learned  it ;  all  in  him  is  fated ;  he  builds  in  a  masterly  manner,  from  a 
constantly  irresistible  impulse.  In  intelligence,  all  results  from  experi- 
ence and  observation :  the  dog  obeys  only  because  he  has  been  taught ; 
all  this  is  free ;  he  obeys  only  because  he  wills  it.  There  are,  then,  in 
animals,  two  distinct  and  primitive  forces:  instinct  and  intelligence.^'--' 

*De  1'  Instinct  et  de  1'  Intelligence  des  Animaux.  Resume  of  the  observations 
of  F.  Cuvier  on  this  subject,  by  M.  Flourons:  2  ed.,  p.  46. 


702  APPENDIX. 


ON     SENSATION,     THE     PRINCIPLE     OP     EXPERIENCE. 

We  have  seen  how  Aristotle  supposed  experience  to  be  derived  from 
sensation.  He  thought  that  the  first  ideas  which  the  senses  awaken  in 
us  are  very  general  ideas.  We  have  seen  afterward  how  Bacon,  Locke, 
and  other  modern  sensitists,  refuted  this  opinion,  and  showed  the  true 
gradation  of  sensible  ideas,  the  real  developement  of  the  experimental  or 
empirical  method. 

But,  when  these  attempted  to  elevate  themselves  by  this  way  to  supra- 
sensible  things ;  when  they  would  establish  on  this  base  the  demonstra- 
tion of  universal  and  necessary  truths,  the  existence  of  natural  religion 
and  morals,  they  were  not  able  to  do  it  on  a  solid  basis.  Their  proofs 
and  their  arguments  vanished  in  the  light  of  vigorous  argumentation,  as 
the  cloudy  vapor  disappears  under  the  rays  of  the  sun.  By  endeavoring  to 
establish  morals  on  sensible  ideas  exclusively,  they  disturbed  them,  they 
opened  the  door,  unknowingly,  to  skepticism,  materialism,  and  atheism. 

The  domain  of  knowledge  which  is  derived  from  sensation,  is  vast 
enough,  without  any  one  attempting  to  extend  it  beyond  its  natural 
limits  ;  for  it  embraces  all  the  sciences  which  are  occupied  with  the  laws 
of  matter,  whether  organized  or  unorganized ;  it  comprehends  physics, 
properly  said,  natural  history,  chemistry,  medicine,  etc.;  all  the  arts  and 
trades  arc  in  its  dependence.  These  are  the  sciences  whose  principle 
lies  in  the  faculty  of  sensation,  which  grow  by  observation  or  experience, 
and  must  be  cultivated  by  the  empirical  method. 

ON   REFLECTION   OR  CONSCIOUSNESS,   THE   PRINCIPLE   OP   PURE   REASON. 

The  human  mind  possesses  the  faculty  of  isolating  itself  from  all  exte- 
rior sensation,  to  fall  back  upon  itself  and  contemplate  its  own  functions. 
This  faculty,  which  is  named  rejtectioti  or  consciousness,  is  the  source  of 
the  most^sublime  knowledge ;  for  it  is  by  this  that  man  rises  to  ideas  of 
the  absolute,  the  necessary,  the  universal,  the  infinite,  the  good,  or  the 
evil ;  in  a  word,  to  all  the  notions  which  constitute  the  exclusive  domain 
of  pure  reason.  The  sciences  which  are  derived  directly  from  it,  arc,  logic, 
metapln-sics,  and  morals.  This  faculty  alone  puts  an  immeasurable 
distance  between  the  human  species  and  the  animal  species  nearest  in 
the  scale  to  man,  in  the  language  of  the  physiologist,  the  most  competent: 

"  Animals,"  say  F.  Cuvier  and  Flourons,  "  receive  by  their  senses 
impressions  similar  to  those  which  we  receive  by  ours ;  they  preserve, 
like  us,  the  trace  of  these  impressions ;  these  preserved  impressions  form 
for  them,  as  for  us,  numerous  and  varied  associations ;  they  combine 
and  deduce  relations  and  judgment  from  them;  they  possess,  therefore, 
intelligence.     But  all  their  intelligence  is  reduced  to  what  is  said  of  it 


NINTH   LETTER.  703 

above.  The  intelligence  which  they  possess  does  not  consider  itself,  does 
not  see  itself,  dses  not  know  itself.  They  possess,  therefore,  no  reflection. 
that  faculty  which  the  human  mind  possesses,  with  which  to  study  itself. 
Keflection,  thus  defined,  is  therefore  the  limit  which  separates  the  intel- 
ligence of  man  from  that  of  animals.  '•'  '-'  Man  is  the  only  one  of 
created  beings  to  whom  the  power  has  been  given  to  feel  that  he  feels, 
to  know  that  he  knows,  and  to  think  that  he  thinks."  =■•' 

The  philosophers  who  have  endeavored  to  study  the  material  world 
by  the  speculative  method,  or  pure  reason,  without  the  aid  of  experi- 
ence— such  as  Plato,  Descartes,  Malebranche,  Leibnitz,  and  others — have 
only  succeeded  in  making  a  fantastic  and  imaginary  world,  on  the  model 
of  their  supra-sensible  ideas.  Sometimes  they  have  refused  to  matter 
every  species  of  force  or  activity  ;  sometimes  they  have  despoiled  it  of  its 
existence  even ;  they  have  pushed  on  blindly  to  the  denial  of  the  reality 
of  bodies ;  in  a  word,  they  have  found  nothing  reasonable,  concerning 
the  objects  which  fall  under  the  senses.  As  a  compensation,  they  are 
sublime  and  admirable,  when  speaking  of  supra-sensible  things ;  they 
have  developed  with  a  superior  logic  the  soundest  ideas  touching  religion 
and  morals. 

ECLECTIC     DOGMATISM. 

We  see  from  what  has  already  been  stated  that  certain  philosophers 
were  led  astray  by  endeavoring  to  rise,  by  ideas  derived  from  sensations. 
to  the  most  abstract  thoughts  of  the  human  mind,  and  others  by  attempt- 
ing to  deduce  the  laws  and  properties  of  matter  from  pure  perceptions 
of  the  mind.  Eationalists  and  Sensitists  have  all  committed  the  same 
fault ;  all  have  interrogated  a  faculty  of  the  soul  on  objects  with  which 
this  faculty  is  not  connected.  Is  it  astonishing,  then,  that  they  have 
both  fallen  into  palpable  errors — errors  which  shock  common  sense  ? 

May  we  not  represent  sensation  and  reflection  as  two  windows,  one  of 
which  opens  on  the  natural  or  sensible  world,  and  the  other  on  the 
immaterial  or  supra-sensible  world.  As  long  as  our  minds  abstain  from 
looking  through  but  one  of  these  windows,  it  sees  necessarily  but  one 
world  ;  it  acquires  only  one  kind  of  ideas,  and  it  is  led  naturally  to 
doubt  the  reality  of  the  other  world,  to  deny  the  existence  of  the  other 
order  of  ideas.  Wisdom  consists,  then,  when  we  wish  to  make  dis- 
coveries in  a  science,  in  examining  without  prejudice  what  order  of 
ideas  this  science  developes,  in  order  to  make  choice  of  the  method  which 
is  best  adapted  to  it. 

By  a  unique  privilege  mathematics  includes  the  two  grand  orders  of 
ideas  which  divide  the  intellectual  sphere  of  man.     It  realizes,  in  some 

"  Pages  49  and  50. 


704  APPENDIX. 

sort,  the  union  of  spirit  with  matter  ;  on  this  account  they  may  be  studied 
either  by  the  speculative  or  by  the  sensitist  method.  The  mathematician 
can  at  his  pleasure  materialize  his  abstract  conceptions,  by  the  aid  of 
signs,  or  idealize  sensible  results,  and  generalize  particular  observations, 
by  means  of  formula.  On  this  account  mathematical  propositions  have 
a  character  of  certainty  which  is  not  found  in  any  other  science,  and  for 
this  reason  they  irresistibly  convince  the  mind.  Taking  hold  of  it  by 
the  way  of  speculation  and  experience,  they  leave  no  door  open  to  doubt 
or  uncertainty. 

§  VI,  Classification  of  Medicink  in  a  General  System  of  Sciences. 

From  what  has  been  said  nothing  is  easier  than  to  determine  to  what 
order  of  ideas  medical  science  belongs,  and  what  method  of  study  is 
most  appropriate  to  its  advancement.  No  one,  I  presume,  will  attempt 
to  class  it  with  sciences  purely  rational,  as  metaphysics  ;  but  every 
body  will  agree  to  rank  it  among  the  sciences  which  treat  of  sensible 
objects,  as  physics,  chemistry,  etc.  Now  the  method  which  succeeds 
best  in  this  order  of  knowledge,  the  one  which  the  great  observers  of 
all  times  have  followed,  according  to  common  opinion  and  the  testimony 
of  history,  is  that  which  is  called  by  modern  philosophers,  indifFer^ 
ently,  experimental  or  empirical,  and  consists,  as  we  have  already 
said,  in  abstracting  by  thought  what  belongs  in  common  to  the  par- 
ticular facts  furnished  by  observation,  in  order  to  form  at  first  generali- 
ties of  a  limited  kind,  then  rising  afterward  by  gradations  to  other 
generalities,  more  and  more  vast  and  more  and  more  abstract. 

The  other  method,  on  the  contrary,  that  is,  the  one  which  proceeds 
from  generalities  to  particulars,  from  axioms  to  consequences,  may  find 
its  application  in  the  teaching  of  Medicine,  whenever  the  question  is 
not  one  of  discoveries  to  be  made,  but  of  pure  and  simple  exposition  of 
knowledge  already  acquired. 


ON     HYPOTHESK 


We  have  admitted  hypothesis  in  physiology  and  in  pathology  as  a 
means  of  uniting  and  co-ordinating  phenomena  among  themselves,  which 
without  some  artificial  bond  of  union  would  remain  isolated  from  each 
other,  and  would  have  no  connection  perceptible  by  our  senses  or  reason, 
and  therefore  would  escape  too  easily  from  the  memory.  But  we  have 
added,  and  cannot  too  often  repeat,  that  a  physio-pathological  hypothesis 
should  never  be  the  basis  of  treatment.  It  can,  at  most,  be  tolerated 
as  a  provisional  motive  of  a  therapeutical  essay,  before  experience  has 
spoken  ;  even  then,  however,  it  is  not  without  danger,  though  limited 


NINTH   LETTER.  705 

to  this  transitory  use ;  it  would  be  better  to  experiment  without  any 
preconceived  idea.  Thus  comprehended,  hypothesis  conforms  to  the 
analogism  of  the  ancient  Empirics  ;  but  in  no  case  should  it  form  any 
part  of  therapeutics,  constituted  as  a  science. 

I  am  reproached  for  pulling  down  medical  practice  and  reducing  it  to 
a  state  of  pure  empiricism  ;  my  brethren  who  have  offered  this  objection 
deceive  themselves,  because  they  attach  to  the  word  empiricism  a  trival 
and  abusive  sense,  which  is  not  that  of  philosophic  language.  Should 
I,  from  a  regard  to  a  vulgar  prejudice,  abstain  from  an  exact  and 
established  expression,  and  replace  it  by  some  one  of  the  common 
epithets  with  which  so  many  writers  clothe  their  medical  theories  ?  I 
have  not  thought  so ;  I  think  I  have  made  enough  concession  to  this 
prejudice  in  adding  to  the  word  empiricism  the  epithet  methodic,  to  dis- 
tinguish it  from  that  ignorant  and  blind  empiricism  with  which  a  careless 
reader  might  have  confounded  it. 


§VII.    Ox    Certaixty   in    Medicine. 

Philosophers  distinguish  two  species  of  certainty,  metaphysical  cer- 
tainty and  empirical  or  experimental  certainty.  The  first  admits  not 
even  the  possibility  of  an  exception ;  thus,  the  following  propositions 
have  a  metaphysical  certainty  :  tico  quantities  equal  to  a  third  are  equal 
to  each  other ;  a  straight  line  is  the  shortest  distance  between  two 
points  ;  nothing  happens  without  a  cause.  Empirical  certainty  exists 
wherever  the  terms  of  a  proposition  express  an  idea  to  which  there  is  no 
known  exception.  Thus,  all  bodies  have  iveight — the  earth  turns  inces- 
santly around  the  sun — are  propositions  which  oflFer  an  example  of 
empirical  certainty. 

We  see  by  these  examples,  that  the  word  certainty,  taken  in  its  rigor- 
ous philosophic  acceptation,  does  not  admit  of  degrees.  A  thing  is  cer- 
tain or  it  is  not — this  is  all ;  but  we  cannot  say  that  it  may  be  more  or 
less  certain,  little  certain,  or  very  certain.  On  the  contrary,  in  common 
language,  the  word  certainty,  being  synonymous  with  probability,  admits 
of  numerous  degrees  and  shades,  and  it  is  in  this  last  sense  that  we  in- 
quire into  the  degree  of  certainty  of  Medicine. 

Cabanis,  who  felt  how  much  it  is  necessary  for  the  success  of  prac- 
tical medicine  that  the  physician  and  the  patient  have  a  reasonable 
faith  in  the  efficacy  of  the  Art ;  in  order  that  the  former  embrace  the 
study  and  practice  of  his  profession  with  that  conscientious  zeal  which 
can  alone  enable  him  to  surmount  the  difficulties ;  and  that  the  latter 
execute  the  prescriptions  of  science  with  that  confident  submission  and 


706  APPENDIX. 

exactness  which  procures  most  frequently  success ;  Cahanis,  I  say,  has 
devoted  a  long  memoir  to  the  discussion  of  the  question  of  certainty  in 
Medicine  ;  and  Broussais,  following  in  his  track,  has  treated  the  same 
subject  in  nearly  the  same  manner.  The  plan  adopted  by  these  authors 
would  carry  us  too  far;  I  am  obliged  to  restrain  myself  in  much 
narrower  limits — but  I  hope  I  reach  the  same  end  by  a  much  shorter 
way,  by  looking  only  on  the  practical  side  of  the  question. 

In  what  respect  is  it  important  both  to  physician  and  patient,  to  know 
the  degree  of  certainty  in  Medicine  ?  Is  it  not  in  order  to  be  assured 
whether  it  would  be  better  to  abandon  diseases  to  the  sole  resources  of 
nature,  or  to  treat  them  conformably  to  the  rules  of  Art  ?  Every  one 
will  agree  that  this  is  the  only  useful  side  of  this  discussion,  and  the 
writers  who  have  agitated  it,  have  not  treated  it  from  any  other  point 
of  view,  whether  they  have  decided  in  favor  of  or  against  science. 

Eeduced  to  these  terms,  the  question  of  the  certainty  of  Medicine 
seems  to  me  easy  to  resolve  ;  indeed,  if  I  consult  history,  I  find  that  no 
nation,  civilized  or  savage,  has  ever  been  without  some  kind  of  Medicine 
either  learned  or  ignorant,  natural  or  superstitious.  If  I  interrogate 
common  sense  and  the  intimate  sentiment,  I  find  that  it  is  impossible  for  a 
man  who  suflers,  to  keep  himself  perfectly  quiet,  without  asking  any 
relief  of  the  experience  of  his  fellows,  as  has  been  advised  by  certain 
very  stoical  philosophers.  The  most  obstinate  skeptics,  the  most  violent 
detractors  of  the  Healing  Art,  if  they  dislocate  an  arm  or  break  a  leg, 
do  not  hesitate  to  call  in  the  assistance  of  the  surgeon,  or  even  a  bone- 
setter.  Where  is  the  man,  who,  seeing  an  infant  attacked  with  convul- 
sions, or  an  old  man  fall  down  paralysed,  would  not  call  a  physician  ? 
Did  Montaigne  and  J.  J.  Eousseau,  those  two  lovers  of  paradox,  who 
were  both  afl3icted  with  the  gravel,  deprive  themselves  of  the  aid  of 
surgery  when  they  could  not  urinate  ? 

FIRST     OBJECTION. 

But,  reply  those  who  are  very  incredulous  in  regard  to  medicine,  if 
there  are  cases  where  the  intervention  of  art  is  indispensable,  and  truly 
eflicacious,  in  how  many  other  cases  has  not  this  intervention  been  more 
injurious  than  useful  ?  How  can  we  definitely  establish  the  balance 
between  the  good,  and  the  evil  which  results  from  it  ? 


Since  you  are  forced  to  admit  that  the  intervention  of  art  is  some- 
times useful  and  necessary,  who  shall  decide  properly  on  the  opportunity 
or  inopportunity  of  this  intervention '?  The  man  who  is  most  familiar 
with  the  resources  of  art,  or  he  who  is  completely  ignorant  of  them  ? 


NINTH   LETTER.  707 

Would  you  call  a  mason  to  decide  whether  a  luxation  is  reducible,  or 
if  a  fracture  of  the  cranium  requires  the  operation  of  trephining? 
Would  you  ask  an  engineer  if  it  is  proper  zo  bleed  a  man  attacked  with 
imminent  suffocation,  or  if  it  would  bo  better  to  vomit  him,  or  apply  an 
irritating  foot-bath?  You  see  that  the  question  of  opportunity  or 
inopportunity  of  the  aid  of  medicine  can  be  properly  resolved  only  by 
him  who  is  in  possession  of  medical  science. 

BECOND     OBJECTION. 

It  is  insisted,  that  if  the  practitioner  is  really  more  apt  than  any  one 
else  of  judging  the  cases  in  which  science  should  interfere,  he  has  often 
an  interest  opposed  to  that  of  the  patient,  and  it  is  to  be  feared  at  least, 
that  in  this  conjuncture  his  zeal  may  be  somewhat  abated. 


It  can  not  be  denied  that,  in  the  present  state  of  society,  the  interest 
of  the  physician  is  not  unfrequently  in  opposition  to  that  of  his  patient, 
especially  when  the  latter  is  very  rich.  But  this  is  no  longer  a  ques- 
tion of  science,  but  one  of  probity  and  of  social  organization ;  it  is  for 
the  legislator  to  devise  the  means  to  harmonize  these  two  opposite 
interests,  to  arrange  them  in  such  a  manner  that  both  shall  concur  to 
the  same  end — the  prompt  cure  of  the  patient.  In  the  meantime,  the 
wisest  part  consists  in  making  choice  of  an  honorable  as  well  as  a  skillful 
physician ;  to  inquire  into  the  morality  of  the  man  to  whom  is  confided 
the  care  of  health  and  life,  with  as  much  solicitude  as  we  inquire  into 
the  morality  of  the  notary  or  advocate  to  whom  we  commit  the  charge 
of  our  fortunes.  We  must  not  hesitate  on  any  occasion  to  prefer  a 
practitioner  of  limited  knowledge  but  known  probity,  to  one  of  high 
scientific  renown  but  of  suspected  morality ;  for  if  the  case  is  difficult 
or  doubtful,  the  first  will  not  hesitate  to  ask  for  a  consultation  with  a 
more  skillful  colleague  than  himself,  and  the  patient  will  thus  have  the 
advantage  of  probity  directed  by  science.  Fortunate  is  the  patient  who 
encounters  these  two  qualities  united  in  the  same  physician ;  the  best 
plan,  then,  is  to  abandon  himself  with  confidence  to  the  counsels  of  such 
a  director ;  he  has  put  his  life  and  his  health  under  the  most  favorable 
chances,  as  far  as  the  limited  wisdom  of  man  can  determine. 


TAELE    OF   CONTENTS 


Introduction,        ._. ....9 

Synoptic  Table  of  the  Ages  and  Periods  in  Medicine, 24 

BOOK  FIRST— AGE  OF  FOUNDATION. 

Extending  from  the  Origin  of  Society  to  the  end  of  the  Second  Century  of  the  Christian  Era. 

I.  PRIMITIVE  PEPtlOD,  of  variable  length  among  different  nations,   -        -  25 

General  Considerations, 25 

Chap.       I.  Medicine  of  the  Antique  Nations, -        -  26 

§      I.  Medicine  of  the  Egyptians, 26 

§    IL  Medicine  of  the  Hebrews, -  32 

§   in.  Medicine  of  the  Oriental  Indians, 36 

§   IV.  Medicine  of  the  Chinese,        ...-...-  38 

§     V.  Medicine  of  the  Greeks,  during  the  Primitive  Period,       -        -  45 

Chap.    II.  Medicine  of  some  other  nations  of  the  Old  and  New  World,  -        -  53 

Chap.  HI.  Origin  of  Medicine,   ---------  53 

Chap.  IV.  The  Utility  of  Medicine  during  the  Primitive  Period,    -        -        -  55 

Resume  of  the  Primitive  Period, 59 

II.  MYSTICAL  PERIOD,  comprising  a  space  of  time  extending  from  the 

Trojan  War,  B.  C,  1184,  to  the  dissolution  of  the  Pythagorean  So- 
ciety, B.  C,  500, -        -        -        -  Gl 

General  Considerations, ---Gl 

Chap.      I.  The  Practice  of  Medicine  in  the  Temples,      -----  62 

Chap.     II.  On  Dreams, 64 

Chap.  III.  Medical  Teaching  in  the  Temples, 66 

Chap.  IV.  The  Origin  of  Classifications  in  Pathology,         .        -        -        .  68 

Chap.     V.  Therapeutics, 70 

Chap.  VI.  Origin  of  Systems,    - -        -        -  73 

Resume  of  the  Mystical  Period, 75 

III.  PHILOSOPHIC  PERIOD,  comprising  the  period  of  time  between  the 

dispersion  of  the  Pythagorean  Societies,  in  the  year  B.  C,  500,  and  the 

foundation  of  the  Alexandrian  Library,  in  the  year  B.  C,  320,  -  78 

General  Considerations, 78 

Pythagoras, 78 

Chap.      I.  Doctrine  of  Pythagoras, 83 

Chap.     II.  Periodic  Physicians, 88 

Chap.  III.  The  Practice  of  Medicine  in  the  Gymnasia,       -        -        -        -  89 


710  TABLE   OF  CONTENTS. 

Chap.      IV.  Schools  of  the  Asclepiadse, -    90 

Art.    I.  Hippocrates, --91 

Art.  II.  The  Hippocratic  Collection, -        -    94 

§        I.  Anatomy  and  Physiology, 94 

§      n.  Hygiene. 96 

§    in.  Pathology  and  Therapeutics, .---..-        97 
§    IV.  Semeiotics.  ----.-..-.     93 

§      V.  Internal  Nosography, 102 

On  Pneumonia,- 103 

On  Pleurisy,    -        - 105 

§     VI.  Therapeutics, 106 

Treatment  of  Pleurisy  and  Pneumonia,  .         -        -        -      107 

§   VII.  External  Nosography  and  Therapeutics,  or  Surgery,  -        -  108 

§  VIII.  Obstetrics,      --.----.-.      109 

§     IX.  Clinics, 110 

First  Constitution, 113 

First  Case, •        -        -  114 

§       X.  Aphorisms, -        115 

Art.  III.  Theories  and  Systems, 117 

§        I.  Theory  of  Coction  and  Crisis, 118 

§       II.  Theory  of  Four  Elements  and  Four  Humors,    -        -        -        -  123 

§     III.  Theory  of  Fluxions, 129 

§     IV.  Theories  founded  on  the  consideration  of  Two  Elements,   -        -  132 

§      V.  Theory  of  a  Single  Element, 136 

§     VI.  Theory  of  any  Excedent,   --------  138 

§    Vn.  Resume  of  the  Hippocratic  Theories, 144 

Chap.        V.  The  Medical  School  of  Cos  after  Hippocrates,    -        -        .        -  145 

Art.    I.  Plato, -      147 

Art.  II.  Aristotle, 153 

Resume  of  the  Primitive  Period, 164 

IV.  ANATOMICAL  PERIOD,  comprising  the  i)eriod  of  time  which  extends 
from  the  Foundation  of  the  Alexandrian  Library,  some  three  hundred 
and  twenty  years  before  Christ,  to  the  death  of  Galen,  in  the  3'ear  two 

hundred,  of  the  Chi-istian  Ei-a, 166 

General  Considerations, 166 

Chap.        I.  The  School  of  Alexandria, 168 

Chap.       H-  Anatomy  and  Physiology, 171 

Chap.      HI.  Hygiene, 180 

Chap.      IV.  General  Pathology, -  183 

Chap.       V.  Internal  Pathology,  -        . 184 

§    I.  Semeiotics, 184 

§   II.  Nosography, 186 

On  Pneumonia,   -.-.---.--  188 

Chap.      VI.  Internal  Therapeutics,     -        - 190 

Cure  of  Peripneumonia,      - --  192 

Chap.     VH.  External  Pathology  and  Therapeutics, 194 

Chap.   VIII.  Clinics, 199 

Chap.      IX.  Theories  and  Systems,     ----..--       200 
General  Considerations, 200 


TABLE   OF  CONTENTS.  711 

Art.     I.  On  Dogmatism,       -.-.'----      202 

Art.   n.  On  Empiricism, 211 

Art.  m.  On  Methodism, -        -        -      224 

Art.  rV.  On  Eclecticism, 233 

Resume'  of  the  Anatomical  Period, 236 

BOOK   SECOND.— AGE   OF   TRANSITION. 

Commencing  at  the  death  of  Galen,  during  the  reign  of  the  Emperor  Septimus  Severus,  A.  D. 
201,  and  ending  at  the  revival  of  Letters  in  Europe,  about  the  year  1400. 

V.  GREEK  PERIOD,  including  the  period  of  time  between  the  death  of  Galen, 
and  the  destruction  of  the  Alexandrian  Library,  ■which  occurred  in  the 

year  640, 237 

General  Considerations,  ...  ..-._      237 

Chap.    I.  Celebrated  Commentators, -  238 

§    L  Oribasius, 238 

§  n.  Aetius, 240 

§  m.  Alexander  of  Tralles,  -  • 241 

§  IV.  Paul  .Egineta, 244 

Chap.   TT.  ^Medical  Organization, 245 

Chap.  III.  Institutions  accessory  to  Medicine,         - 252 

Resume  of  the  Greek  Period, 254 

VL  ARABIC  PERIOD,  commencing  at  the  destruction  of  the  Alexandrian 
Library,  in  the  year  G40  of  the  Christian  era,  and  ending  at  the  close 
of  fourteenth  century,  .........  255 

General  Considerations, -      255 

Chap.     I.  Medicine  of  the  Arabs,  ._......  257 

§     L  Rhazes 257 

§    n.  Hally-Abas, 259 

§m.  Avicenna, -        -        -        -        .      260 

§  IV.  Albucasis,       .  -  264 

§    V.  Retrospective  considerations  on  the  progress  of  Medicine  among 

the  Arabs, -        -  266 

Chap.   II.  Medicine  of  the  Greeks  during  the  Arabic  Period,     -        -        -      267 
Chap.  IIL  Medicine  of  the  Latins  during  the  same  Period,    .        -        -        -  269 

General  Considerations, 269 

Art.     I.  Medical  Organization  of  the  West,         - 271 

Art.   n.  School  of  Salermo, 275 

Art.  ni.  On  the  Origin  and  Growth  of  Universities, 277 

§    I.  From  Charlemagne  to  the  fifteenth  Century,       ....      277 
§  n.  Efforts  of  some  Physicians  to  restore  the  Science,  ...  279 

Chap. IV.  Accessory  Institutions,        - 284 

Resume  of  the  Arabic  Period,        .        - 285 

BOOK    THIRD.— AGE    OF    RENOVATION. 

Extending  from  the  commencement  of  the  Fifteenth  Century  to  the  Present  Time. 

Vn.  ERUDITE  PERIOD,  including  the  fifteenth  and  sixteenth  Centuries,    -  287 

General  Considerations, 287 

Chap.        I,  Humanist  Physicians, --  289 


712  TABLE   OF  CONTENTS. 

Chap.      II,  Anatomy  aud  Physiology, 293 

Chap.    III.  Hygiene,  Mondini,  Berenger,  Vesalius,  Servetus,  R.  Columbus, 

Cesalpine,  Louis  Carnaro, 299 

Chap.     IV.  General  Pathology,  -        -        - 302 

Chap.      V.  Internal  Pathology,      ---..-.--  303 

§       I.  Semeiotics,        -        - 303 

§     II.  Pathological  Anatomy, 304 

§    m.  Nosography, 305 

Chap.    VI.  Internal  Therapeutics,  Doctrine  of  Contraries,    -        -        -        -  308 

§       I.  On  Evacuating  Medication, 321 

Derivation  and  Revulsion, 322 

§      II.  Purgative  Medication, 324 

§    III.  Alterant  Medication, 325 

Chap.    VII.  External  Pathology  and  Therapeutics, 328 

Barber  Surgeons,         - -  330 

Ambrose  Pare, 331 

Obstetrics, 336 

Chap.  VIII.  Clinics, 336 

§       I.  Syphilis,  considered  as  a  new  Disease, 341 

§     II.  Its  origin  in  America  considered, 341 

§    in.  A  degeneration  of  Leprosy,  ...  ...  343 

Chap.    IX.  Theories  and  Systems, 346 

General  Considerations,        .---..--  346 

John  Fernel,      - 346 

§  I.  Doctrine  of  Galen  on  the  Elements,  Humors,  etc.,  ...  349 
§  II.  Dissertation  on  the  Essence,  Causes,  and  Symptoms  of  Diseases,  350 
§    III.  Therapeutics,  Examples  of  Cures,        .-,-..  351 

Chap.     X.  Occult  Sciences,         - 352 

§       I.  Cornelius  Agrippa, 353 

§     II.  .Jerome  Cardan, 357 

§   m.  Paracelsus,    ----- 358 

Conclusion  of  Chapter  X, 369 

Chap.   XI.  Partial  efforts  for  Reform, 370 

§      I.  John  Argentier, 370 

§    II.  Leonard  Botal, 371 

§  III.  Laurence  Joubert, 372 

Chap.  XII.  Medical  Organization  and  Accessory  Institutions,        -        -        -  378 
Resume  of  the  Erudite  Period,  ---.-.      378 

Vni.  REFORM  PERIOD,  comprising  the  seventeenth  and  eighteenth  Cen- 
turies,  -        -        -        - 380 

General  Considerations,  - 380 

Chap.        I.  Anatomy  and  Physiology,    -        - 382 

Circulation  of  the  Blood, 382 

William  Harvey, 383 

Malpighi, 385 

Senac, 386 

Respiration,     ----.---..      387 

Lymphatic  System, 390 

Nervous  System, 392 


TABLE  OF  CONTENTS.  713 

Generation, 397 

Vital  or  Organic  Properties, 400 

Francis  Glisson,  ...- 402 

Albert  Von  Haller, 402 

John  Hunter, 405 

Chap.       n.  Hygiene, 406 

§         I.  Public  Hygiene, 406 

Among  the  Ancients,       -- 406 

Fasting  among  Turks  and  Christians, 407 

Lazarettos, 408 

General  attention  to  Hygiene,    ----.-.  409 

Inoculation, 410 

Jenner,    - 410 

Vaccination,    -        - 411 

Private  Hygiene, 411 

Sanctorius, 411 

Cheyney, 413 

Chap.     HE.  General  Pathology, 414 

Chap.      TV.  Internal  Pathology, 415 

§        I.  Semeiotics,       ..- 415 

Sphygmics,         -...-....-  416 
Percussion,      ....-        .....      417 

Avenbrugger, 417 

§       n.  Pathological  Anatomy, '       418 

Bonet,         -        - 418 

Morgagni, 419 

Bichat, 420 

§     HL  Nosography, 421 

System  of  Sauvages, 423 

System  of  CuUen, 425 

System  of  Pinel, 426 

Systems  of  Linnasus  and  others,     -.--.-      427 

System  of  Bouillaud.    Note, 429  ■ 

Chap.       V.  Internal  Therapeutics, 430 

Treatment  of  Syphilis, 430 

Treatment  of  Periodical  Diseases, 433 

Introduction  of  Cinchona, 434 

Treatment  of  other  diverse  Diseases, 437 

Chap.      VI.  External  Pathology  and  Therapeutics, 439 

General  Remarks, 440 

Wounds  of  the  Head,  .....---  441 

Diseases  of  the  Eye,        -        - 442 

Cataract, 442 

Fistula  Lachrymalis, 443 

Synizesis,  .--. 443 

Diseases  of  the  nose,       --...---      444 

Nasal  Polypus, 444 

Rhinoplasty, 444 

Diseases  of  the  Mouth, 446 

45 


714  TABLE  OF  CONTENTS. 

Hare  Lip, --         -      445 

Aflfections  of  the  Teeth, — Dentistry,         ...        -  446 
Affections  of  the  Tongue,  Palate,  and  Tonsils,      -        -      447 

Diseases  of  the  Ear, 448 

Obturation  of  the  Air  Passages, 448 

Diseases  of  the  Chest, 449 

Empyema, -      449 

Diseases  of  Abdominal  Organs,  ....  .  451 

Wounds  of  Abdomen  and  Intestines,    -        -        -        .      451 

Paracentesis  Abdominalis, 452 

Hernia, 453 

Diseases  of  Urinary  Organs, 454 

Cystotomy,   --. 455 

Diseases  of  the  Genital  Organs  in  Man, 457 

Hydrocele, 457 

Sarcocele, 458 

Diseases  of  the  Anus,      ..--....      459 

Diseases  of  the  Members, 469 

External  Aneurisms,    .......      459 

Amputation  of  Members,         ......  459 

Orthoptedia,  ........      461 

Chap.     VIL  Obstetrics, -  462 

Pregnancy, 464 

Natural  Labor, 464 

Difficult  Labor,         ...         - 465 

The  Placenta, 466 

Chap.  VIII.  Legal  Medicine, 467 

Chap.     IX.  Clinics, 470 

§        I.  Oral  Clinical  Teaching, 471 

Bottoni,  Oddo,  De  Huern,  Sylvius,  Boerhaave,     ....  471 
§       II.  Collection  of  Clinical  Observations,  ....        -      474 

I      HI.  Epidemic  Constitutions,      ..--.-..  474 

Baillou,    ...        - .      474 

Difference  between  Galenism  and  modern  Hippocratism,    .        .  476 

Sydenham, 477 

Stoll, 480 

§      IV.  Medical  Topography, 482 

Alpin,  Bontius,  Pison,  Koempfer,        -...-.  432 

Desportes,  Cleghorn,  Lind,  Hillory, 483 

Chalmers,  Bajon,  Falconer, 483 

Daniel  Drake,  -- -      484 

Ch/Vp.       X.  Theories  and  Systems,        --.-....  435 

Pi'eliminary  Reflections, --      485 

Art.       I.  Historic  Sketch  of  Philosophy  during  the  Seventeenth  and  Eight- 
eenth Centuries, 4SG 

§        I.  Retrospective  Considerations,  -...---      486 
§       II.  On  Modern  Sensualism  and  Reasoning  by  Induction,  -        -  488 

Francis  Bacon, 488 

John  Locke, 492 

Stephen  Bonuat  de  Condillac, 493 


TABLE  OF  CONTENTS.  715 

Aphorism  of  Philosophy,  particularly  applicable  to  the  Physi- 
cal Sciences,-    ----- 493 

First  Paradox  of  Condillac :  The  Art  of  Reasoning  may  be  re- 
duced to  a  ■well  formed  Language,  ------  494 

Second  Paradox  :  Analysis  is  the  sole  ]\Iethod  for  the  Acquisi- 
tion of  Knowledge,       .-...-.-      496 
§      in.  On  Rationalism,  or  Reasoning  by  Deduction,    -        -        -        -  499 

Descartes, 500 

Leibnitz, 503 

Kant, 506 

§      IV.  Conclusion, -        -        -  606 

Art.     n.  Sources  of  Animism  and  Chymiatria, 509 

Van  Helmont, 509 

Art.    m.  latro-Chymia, 513 

Sylvius, 513 

Willis, 516 

Art.    IV.  latro-Mechanics, 520 

Borelli, 620 

Baglivi, 625 

Boerhaave,       --- 630 

Art.      V.  Animism  and  Vitalism, 634 

Stahl, 634 

Barthez,      -        -        - 639 

Art.    VI.  Organic  Dynamism, 547 

Hoffman, 547 

CuUen, 552 

Brown, 555 

Art.  VII.  Empiricism, -..      561 

Werlhof, 567 

Lieutaud, 567 

Chap.      XI.  Empiri-Methodism,  or  the  Alliance   of   Empiricism  with  the 

Philosophic  JSIethod,        --------  670 

Universal  Axiom  of  Therapeutics, 570 

First  Condition  required  for  the  Application  of  this  Axiom,      -  571 

Second  Condition, 577 

Third  Condition, 578 

On  Method  in  Therapeutics,  or  Classification  of  the  General 

Modes  of  Treatment, 584 

Synthetic  Mode, 584 

Analytic  Mode,  ..- 585 

Expectant  Mode, 586 

Exploring  or  Perturbating  Mode, 587 

Char     XII.  General  Resume, -..      591 

Phases  in  Medical  History.         -        - 591 


CONTENTS   OF  APPENDIX. 


FIRST    LETTER. 

Medicine  Judged  by  Physicians. 

School  of  Paeis — Scliool  of  Montpelier — Italian  School — Comparison  of  the 
English,  French,  and  Italian  doctrines — German  School — Conclusion :  it  is  not 
astonishing  that  there  are  so  many  skeptics  in  regard  to  Medicine,  when  the 
masters  themselves  declaim  so  against  it, 599 

SECOND    LETTER, 

Is  there  in  Medicine  a  sure  means  of  discovering  the  true  from  the  false — the  certain  from  tlie 

hypothetical  ? 

Importance  of  the  question — ^Final  aim  of  Aledicine :  every  thing  in  this  science  is 
or  ought  to  be  related  to  Therai)eutics — The  supreme  and  infallible  criterion  in 
the  Healing  Art  is  Therapeutical  pi*oof — Universal  Axiom:  all  medication  which 
has  cured  one  disease,  must  cure,  equally,  diseases  which  are  analagous  to  it — 
The  rational  application  of  this  axiom  rests  on  three  indispensable  conditions : 
homogeneousness  of  the  diseases,  identity  of  curative  means,  and  the  knowl- 
edge of  the  treatment  most  appropriate  to  each  morbid  species — Conclusion : 
Medicine  has  always  been  in  possession  of  a  sure  principle  and  method  for  its 
development, • 610 

THIRD   LETTER. 

On  the  causes  which  have  lead  physicians  to  leave  the  primitive  route  of  pure  observation. 
They  are  included  in  this  aphorism :  Art  is  long,  life  is  short,  experience  defec- 
tive, and  judgment  difficult — Consequences  of  this  scientific  revolution — Origin 
of  Physio-Pathological  Systems — Conclusion :  on  this  account,  the  various  sects 
in  Medicine, --  623 

FOURTH    LETTER. 

Can  pathological  physiology,  in  whole  or  in  part,  be  the  direct  or  immediate  foundation  of 

therapeutics  ? 

Present  state  of  Science  in  relation  to  this  question — Differences  in  opinion  among 
ancient  and  modern  authors — Philosophic  axioms  which  aid  in  the  solu- 
tion of  this  problem — Negative  reply  to  the  question  placed  at  the  head  of  the 
letter :  can  pathological  physiology  be  in  any  case  the  direct  and  immediate 
foundation  of  therapeutics  ? — Examples  and  proofs  to  support  this  response — 
Conclusion:  confirmation  of  this  axiom  in  our  Second  Letter,  clinical  proof  is 
the  supi-eme  criterion  of  truth  in  Medicine,        --.-..  635 


718  CONTENTS   OF   APPENDIX. 


FIFTH  LETTER. 

On  Eclecticism  in  Medicine. 
Origin  of  the  New  Eclecticism  in  Medicine,  which  must  not  be  confounded  with 
Eclecticism  in  Philosophy — Eclecticism  in  Pathology — Eclecticism  in  Therapeu- 
tics— Conclusion :   Eclecticism  in   Medicine  is  a  doctrine  essentially  vague, 
shifting,  and  destitute  of  foundation, 646 

SIXTH    LETTER. 

On  Homeopathy. 
The  progress  of  this  doctrine  imposes  upon  us  the  obli  ration  to  consider  it  seri- 
ously— The  philosophy  of  Hahnemann  is  the  most  absolute  Sensitism ;  his 
physiology  and  his  pathology  conduct  us  to  the  grossest  and  narrowest  Empiri- 
cism ;  his  universal  principle  of  Therapeutics,  the  law  of  similars,  is  founded 
on  the  most  remote  and  false  analogies — The  author  continually  promises 
therapeutical  observations,  but  furnishes  none  which  are  avithentic — The  Spe- 
cific School,  having  submitted  the  theorems  of  Hahnemann  to  experimental 
proof,  find  them  to  be  false  or  accidental — Conclusion :  the  Homeopathic  doc- 
trine oifers  the  strangest  assemblage  of  assertions  devoid  of  all  truth,  auda^ 
cious  paradoxes,  and  flagrant  contradictions ;  in  a  word,  is  a  challenge  to  the 
credulity  of  mankind, 664 

SEVENTH    LETTER. 

On  Therapeutical  Methods. 
Present  condition  of  this  branch  of  the  Science — New  Classification  of  Therapeu- 
tical Methods — The  Synthetic  Method,  the  most  perfect  of  all,  is  blindly  denom- 
inated Irrational — Analytic  Method — Comparison  of  the  two  methods — Expec- 
tant Method  called,  improperly,  Natural — Secondary  Methods — Ai^plication  of 
our  Theory  of  Curative  Methods — Various  Methods — Classification  and  Denom- 
ination of  Medicaments — Conclusion — Empiri-SIethodism  is  the  only  one  of  all 
the  Systems  in  Medicine  that  unites  under  one  Principle,  and  embraces  in 
its  scheme  all  Internal  and  External  Therapeutics,  -        -  -        -  666 

EIGHTH    LETTER. 

Kesponse  to  some  Olijections  concerning  the  Empiri-Methodic  Doctrines.  673 

NINTH    LETTER. 

On  the  Rank  tliat  Medicine  should  occupy  in  a  general  System  of  the  Sciences,  and  the  Degree  of 
Certainty  wliich  it  can  attain. 

Value  of  this  inquiry — Division  of  the  subject  of  the  Letter  into  two  parts,  689 

FIRST     PART. 

Historical  resume  of  the  opinions  emitted  by  philosophers  on  the  Origin  of  Ideas,  aud  their 
various  modes  of  development. 

Antique  Period — Middle  Period — Modern  Period — Revival  of  Philosophy — Sen- 
sitism of  Bacon,  Locke,  Condillac,  and  others — Rationalism  of  Descartes,  Leib- 
nitz, Kant,  Fichte,  and  Schelling — Common  Sense  and  Sentiment  considered 
as  a  means  of  Knowledge — The  Scotch  School — Philosophic  Eclecticism  of  our 
TimeB, 690 


CONTENTS   OF  APPENDIX.  719 

SECOND      PART. 

Critical  and  Dogmatical  Examination  of  tlie  various  Systems  just  mentioned. 
Instinct,  the  principle  of  Sentiment  or  Common  Sense,  is  not  a  philosophic  fac- 
ulty, that  is  to  say,  perfectible — Sensation  the  principle  of  experience,  is  the 
source  of  all  Physical  Sciences,  of  all  the  Arts  and  Trades — Reflection  or  Con- 
sciousness, is  the  principle  of  pure  Reason,  and  is  characteristic  of  the  Human 
Species,  the  source  of  all  supra-sensible,  or  a  priori  knowledge — Eclectic  Dog- 
matism— Why  mathematical  theorems  take  hold  of  our  convictions  with  an 

irresistible  force — Classification  of  Medicine  in  a  complete  system  of  science 

Value  of  hypotheses  in  Medicine — Certainty  in  Medicine,         -        -        -  701 


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